新生儿缺氧缺血性脑病中连续脑电监测对惊厥的诊断及抗发作药物疗效的评估

Continuous electroencephalogram monitoring in the diagnosis of neonatal seizures in hypoxic-ischemic encephalopathy and the evaluation of the efficacy of antiseizure medications

新生儿缺氧缺血性脑病(HIE)是新生儿期最常见的脑损伤形式之一, 其突出的临床表现之一即为新生儿惊厥发作。惊厥负荷的高低与脑损伤的严重程度密切相关。连续视频脑电图监测是新生儿惊厥诊断的金标准, 在新生儿惊厥诊断中具有重要作用, 可区分惊厥与非惊厥运动现象。HIE患儿惊厥发作表现不一, 发作类型根据是否伴有临床症状, 分为电-临床发作和电发作, 最常见的为电发作。美国临床神经生理学协会建议对HIE婴儿进行至少24 h脑电图监测, 保证及时有效的治疗。抗发作药物(ASM)是治疗新生儿HIE惊厥发作的重要方法, 建议对于新生儿惊厥患儿应尽快给予ASM。在使用ASM同时, 应实施连续视频脑电图监测, 以优化ASM的剂量和用药时长, 减少患儿住院时间, 降低出院时对ASM的需求。

Neonatal hypoxic-ischemic encephalopathy(HIE)stands as one of the most prevalent brain injuries during the neonatal stage,a condition whose salient clinical symptom includes seizures.The extent of the seizure burden is intimately tied to the gravity of the brain injury.Continuous video electroencephalogram(vEEG)monitoring is the gold standard in diagnosing neonatal seizures.It plays a pivotal role in identifying neonatal seizures and distinguishing them from non-seizure motor phenomena,thereby ensuring a precise diagnosis.The classification of seizures in neonate with HIE is dichotomized into electrical-clinical seizures and electrical-only seizures,based on the presence or absence of clinical manifestations.Among these,electrical seizures are the most prevalent type.The American Clinical Neurophysiological Society advocates for a minimum of 24-hour EEG monitoring for infants with HIE to guarantee prompt and efficient treatment.Antiseizure medication(ASM)is a crucial therapy for neonatal HIE seizure episodes,underscoring the importance of administering it promptly to children with neonatal seizures.When utilizing ASM,it is imperative to implement continuous vEEG monitoring to fine-tune the dosage and medication duration,thus shortening patient stays and diminishing the necessity for ASM upon discharge.