Carlotta Facini

Real-time automated detection of clonic seizures in newborns

OBJECTIVE The aim of this study is to apply a real-time algorithm for clonic neonatal seizures detection, based on a low complexity image processing approach extracting the differential average luminance from videotaped body movements. METHODS 23 video-EEGs from 12 patients containing 78 electrographically confirmed neonatal seizures of clonic type were reviewed and all movements were divided into noise, random movements, clonic seizures or other seizure types. Six video-EEGs from 5 newborns without seizures were also reviewed. Videos were then separately analyzed using either single, double or triple windows (these latter with 50% overlap) each of a 10s duration. RESULTS With a decision threshold set at 0.5, we obtained a sensitivity of 71% (corresponding specificity: 69%) with double-window processing for clonic seizures diagnosis. The discriminatory power, indicated by the Area Under the Curve (AUC), is higher with two interlaced windows (AUC=0.796) than with single (AUC=0.788) or triple-window (AUC=0.728). Among subjects without neonatal seizures, our algorithm showed a specificity of 91% with double-window processing. CONCLUSIONS Our algorithm reliably detects neonatal clonic seizures and differentiates them from either noise, random movements and other seizure types. SIGNIFICANCE It could represent a low-cost, low complexity, real-time automated screening tool for clonic neonatal seizures.

Paroxysmal nonepileptic motor phenomena in newborn.

INTRODUCTION Understanding the pathophysiological meaning of paroxysmal nonepileptic motor phenomena in newborns represents a challenge for the clinicians of the Neonatal Intensive Care Unit. METHODS This paper provides an extensive review of the most frequent paroxysmal nonepileptic motor phenomena in newborns, in order to improve the knowledge about this sub-topic of the neonatal pathology and to guide the diagnostic-therapeutic approach. RESULTS The correct identification of an epileptic form, among different motor phenomena, which may clinically mimic seizures, is essential for a correct management, avoiding overtreatment. However, it is likewise important to know and to be able to identify other rare neurological conditions, such as hyperekplexia, spinal muscular atrophy, acute bilirubin encephalopathy, that could make a first appearance with paroxysmal motor manifestations, needing specific diagnostic work-up and treatment. CONCLUSIONS These clinical events should not be underestimated because, even if many times they are physiological and age-related, sometimes they could be the visible signs of an underlying epileptic or nonepileptic neurological disease.

Epileptic and non-epileptic paroxysmal motor phenomena in newborns

Abstract Objective: The aim of this study is to provide an extensive overview of the clinical features of neonatal paroxysmal motor phenomena, both self-limited, related to the immaturity of the central nervous system, and pathological (epileptic and non-epileptic), in order to help the diagnostic approach. Methods: We reviewed the scientific literature about epileptic and non-epileptic paroxysmal motor phenomena in newborns. Results: Paroxysmal motor phenomena in newborns represent a challenge for the clinicians due to the different underlying pathophysiological mechanisms. A proper differential diagnosis is required. Conclusions: There are some clinical features that may help clinicians with the differentiation among physiological and pathological, epileptic, and non-epileptic events. However, further investigations are often needed to identify the cause. A continuous synchronized video–electroencephalogram (EEG)–recording, interpreted by an expert in neonatal neurology, remains the gold standard to prove the epileptic origin of a paroxysmal motor phenomenon.

Incidence of neonatal seizures, perinatal risk factors for epilepsy and mortality after neonatal seizures in the province of Parma, Italy

Information about the incidence of neonatal seizures (NS) is scarce. Previous studies relied primarily on a clinical diagnosis of seizures. This population‐based, retrospective study evaluated the incidence of electroencephalography (EEG)–confirmed seizures in neonates born in the province of Parma and the perinatal risk factors for mortality and epilepsy.

A novel temporal pattern of childhood cerebral X-linked adrenoleukodystrophy

We report a 9-year-old boy, with childhood cerebral X-linked adrenoleukodystrophy (CCALD), presenting with an episode of loss of consciousness, fixed gaze, hypotonia and vomit with spontaneous resolution and post-ictal sleep. Behavioural impairment has been observed since the previous five months. Magnetic Resonance Images (MRI) revealed isolated bilateral, symmetric, confluent temporal white matter lesions involving also corticospinal tracts, with sparing of the parieto-occipital and frontal white matter. This report outlines an atypical neuroradiological localization of X-linked adrenoleukodystrophy and neuropsychological findings not specifically related to the brain involvement seen at the MRI.

Vertex Rolandic Spikes and Central Sleep Apnea in a Newborn

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Early onset of propriospinal-like myoclonus in a child following a vertebral fracture

e see front matter 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2016.03.019 using a thermistor, a strain gauge, and pulse oximetry. The diagnosis was further confirmed by genetic investigation for PHOX2B mutations. Serial EEGs during the first days of life showed negative and biphasic vertex Rolandic spikes (Figure). His brain ultrasound scans were

Hereditary Hemorrhagic Telangiectasia presenting as migraine: A case report

A 9-year-old girl presented with trunk and limb myoclonic status (video at Neurology.org) that started immediately after back trauma that caused a T7 vertebral body fracture without spinal involvement (figure). Myoclonic status became more severe after tactile stimuli and spontaneously disappeared within 32 hours. The jerk-locked back-averaging analysis excluded a cortical origin and the somatosensory evoked potentials, performed after 36 hours, were normal. Full neuropsychological examination and Child Behavior Checklist scores were within normal limits. This represents a novel presentation of early posttraumatic propriospinal-like myoclonus in a child. We hypothesize a transient spinal impairment due to mechanical compression.1,2

Neonatal seizures in preterm newborns: A predictive model for outcome

BACKGROUND Hemorrhagic Hereditary Telangiectasia (HHT) is an autosomal dominant disease characterized by the presence of multiple arteriovenous malformations (AVMs). Migraine is described in association with HHT in adulthood, while only few paediatric cases are reported in the literature. AIM In this paper, we describe an atypical case of HHT in a 7-year-old boy, who presented severe and recurrent episodes of migraine-like headache as the first symptom of the disease. METHODS The patient was accurately investigated both clinically (general, neurological and dermatological examinations), instrumentally (electroencephalogram, brain magnetic resonance, transcranic Eco-color-Doppler, contrast echocardiography and enhanced chest computed tomography) and genetically. RESULTS Familial history was positive for HHT in the paternal line. Both general and neurological examination were normal. Brain magnetic resonance imaging showed a minor old infarct in the right parietal and occipital lobes. Transcranic Eco-color-Doppler, contrast echocardiography and enhanced chest computed tomography revealed a pulmonary AVM. Cephalalgia resolved after transcatheter embolotherapy. A genetic test, identifying the mutation in endoglin gene both in the patient and in the father, confirmed the suspected diagnosis of HHT. CONCLUSIONS Although headache is rarely reported in children as the first symptom of HHT, we warn clinicians on this possible link, as a promptly diagnosis is advisable in order to prevent potential complications.