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Clinical recognition has been the cornerstone of the diagnosis and management of neonatal seizures from the earliest days of care for affected infants, and previous classification systems have been based on these bedside observations. Recently, the Task Force on Neonatal Seizures of the International League Against Epilepsy (ILAE) published a new classification system that has significant implications for the care of newborns suspected of seizures. This new construct includes electroencephalographic (EEG) confirmation rather than reliance solely on clinical observation of seizures.1 For some newborns, it will improve diagnosis and management that may affect long-term neurodevelopmental outcomes. For others, it may emphasize additional disparities in health care requiring new clinical strategies. Here, we discuss the rationale for the development of this new classification, advantages and limitations, potential impact, and new strategies for resource-challenged care centers. [ABSTRACT FROM AUTHOR]

Objective To investigate the seizure response rate to lidocaine in a large cohort of infants who received lidocaine as second- or third-line antiepileptic drug ( AED) for neonatal seizures. Methods Full-term (n = 319) and preterm (n = 94) infants, who received lidocaine for neonatal seizures confirmed on amplitude-integrated EEG (aEEG), were studied retrospectively (January 1992-December 2012). Based on aEEG findings, the response was defined as good (>4 h no seizures, no need for rescue medication); intermediate (0-2 h no seizures, but rescue medication needed after 2-4 h); or no clear response (rescue medication needed <2 h). Results Lidocaine had a good or intermediate effect in 71.4%. The response rate was significantly lower in preterm (55.3%) than in full-term infants (76.1%, p < 0.001). In full-term infants the response to lidocaine was significantly better than midazolam as second-line AED (21.4% vs. 12.7%, p = 0.049), and there was a trend for a higher response rate as third-line AED (67.6% vs. 57%, p = 0.086). Both lidocaine and midazolam had a higher response rate as third-line AED than as second-line AED (p < 0.001). Factors associated with a good response to lidocaine were the following: higher gestational age, longer time between start of first seizure and administration of lidocaine, lidocaine as third-line AED, use of new lidocaine regimens, diagnosis of stroke, use of digital aEEG, and hypothermia. Multivariable analysis of seizure response to lidocaine included lidocaine as second- or third-line AED and seizure etiology. Significance Seizure response to lidocaine was seen in ~70%. The response rate was influenced by gestational age, underlying etiology, and timing of administration. Lidocaine had a significantly higher response rate than midazolam as second-line AED, and there was a trend for a higher response rate as third-line AED. Both lidocaine and midazolam had a higher response rate as third-line compared to second-line AED, which could be due to a pharmacologic synergistic mechanism between the two drugs. [ABSTRACT FROM AUTHOR]

The diagnosis of nonconvulsive status epilepticus ( NCSE) relies largely on electroencephalography ( EEG) findings. The lack of a unified EEG terminology, and of evidence-based EEG criteria, leads to varying criteria for and ability to diagnose NCSE. We propose a unified terminology and classification system for NCSE, using, as a template, the Standardised Computer-based Organised Reporting of EEG ( SCORE). This approach integrates the terminology recently proposed for the rhythmic and periodic patterns in critically ill patients, the electroclinical classification of NCSE (type of NCSE) and the context for the pathologic conditions and age-related epilepsy syndromes. We propose flexible EEG criteria that employ the SCORE system to assemble a database for determining evidence-based EEG criteria for NCSE. [ABSTRACT FROM AUTHOR]