José Ramón Castro Conde

Extrauterine life duration and ontogenic EEG parameters in preterm newborns with and without major ultrasound brain lesions

OBJECTIVE To determine whether extrauterine life duration is associated with different ontogenic electroencephalographic (EEG) patterns in premature infants compared with neonates born at later gestational ages (GAs). METHODS We included 97 preterm infants of 24-36 weeks GA. We performed neurosonography and EEG recordings at week 1 and 2 of postnatal life, then every two weeks until term conceptional age (CA). We analyzed background EEG and sleep states and compared them at matched CA. RESULTS In the group of infants without major ultrasound lesion (MUL), those <29 weeks GA showed increased sawtooth at 32-36 weeks CA and delta brushes from 34 to 40 weeks CA compared to infants > or =29 weeks GA. Infants with MUL compared to those without MUL showed significantly longer interburst intervals, shorter minimum burst duration at 2 and 4 weeks postnatal life, and higher incidence of sawtooth and delta brushes from 34 weeks CA to term. In addition, those of <29 weeks GA had higher rates of indeterminate sleep until 32 weeks CA. The type of MUL most frequently associated with dysmature EEG patterns was persistent ventricular dilatation. CONCLUSIONS Premature infants without MUL showed prolonged dysmature EEG patterns as from early CAs (> or =29 weeks). This finding was more evident in those with MUL. SIGNIFICANCE Extrauterine EEG development in prematures may differ from that of babies born at a later GA.

Positive temporal sharp waves in preterm infants with and without brain ultrasound lesions

OBJECTIVE Clinical significance of neonatal positive temporal sharp waves (PTS) is controversial. The aim of this work is to study (1) PTS incidence in preterm infants with or without major ultrasound lesion (MUL) per gestational age (GA), and (2) the relationship between PTS in both sleep states and other electroencephalographic (EEG) findings with poor prognoses. METHODS 97 preterm infants of <27-36 weeks GA, and 12 full-term healthy infants were presented. Prospective study included (1) neurodevelopmental assessment at 40-42 weeks conceptional age (CA), (2) serial neurosonography, and (3) EEG recording at postnatal week 1, 2, 4 and at 40-42 weeks CA. RESULTS In 50 neonates without MUL, peak PTS was at 31-32 weeks GA. In 47 neonates with MUL, PTS increased significantly from week 2 after birth, descending at the 4th. Neonates of <33 weeks GA with MUL showed significantly increased PTS at term. A significant relationship was found between PTS and other EEG abnormalities with poor neurologic prognoses. PTS incidence varied with sleep states, being predominant in indeterminate sleep in neonates with MUL. CONCLUSIONS PTS increased significantly in infants with MUL, mainly at week 2 of postnatal life, persisting high until term CA, and correlated with other abnormal EEG findings. SIGNIFICANCE PTS are highly sensitive to MUL.

Neonatal Apneic Seizure of Occipital Lobe Origin: Continuous Video-EEG Recording

We present 2 term newborn infants with apneic seizure originating in the occipital lobe that was diagnosed by video-EEG. One infant had ischemic infarction in the distribution of the posterior cerebral artery, extending to the cingulate gyrus. In the other infant, only transient occipital hyperechogenicity was observed by using neurosonography. In both cases, although the critical EEG discharge was observed at the occipital level, the infants presented no clinical manifestations. In patient 1, the discharge extended to the temporal lobe first, with subtle motor manifestations and tachycardia, then synchronously to both hemispheres (with bradypnea/hypopnea), and the background EEG activity became suppressed, at which point the infant experienced apnea. In patient 2, background EEG activity became suppressed right at the end of the focal discharge, coinciding with the appearance of apnea. In neither case did the clinical description by observers coincide with video-EEG findings. The existence of connections between the posterior limbic cortex and the temporal lobe and midbrain respiratory centers may explain the clinical symptoms recorded in these 2 cases. The novel features reported here include video-EEG capture of apneic seizure, ischemic lesion in the territory of the posterior cerebral artery as the cause of apneic seizure, and the appearance of apnea when the epileptiform ictal discharge extended to other cerebral areas or when EEG activity became suppressed. To date, none of these clinical findings have been previously reported. We believe this pathology may in fact be fairly common, but that video-EEG monitoring is essential for diagnosis.