Hypothermia is correlated with seizure absence in perinatal stroke.
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ABSTRACT:
SUBMITTER: Harbert MJ
PROVIDER: S-EPMC3594994 | biostudies-literature | 2011 Sep
REPOSITORIES: biostudies-literature
Publications
Hypothermia is correlated with seizure absence in perinatal stroke.
Harbert Mary J MJ Tam Emily W Y EW Glass Hannah C HC Bonifacio Sonia L SL Haeusslein Laurel A LA Barkovich A James AJ Jeremy Rita J RJ Rogers Elizabeth E EE Glidden David V DV Ferriero Donna M DM
Journal of child neurology 20110623 9
Within a single-center prospective cohort study of neonatal encephalopathy involving 315 subjects, 15 neonates were found to have a focal stroke on magnetic resonance imaging. These 15 patients were matched on the basis of gender and degree of encephalopathy to 30 neonates without stroke from the same cohort. On Bayley Scales of Infant Development, the stroke group had Mental Development Index scores that were 1.7 standard deviations lower compared with controls (P = .007). This association was ...[more]
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Project description:Absence seizures are generalized, cortico-thalamo-cortical (CTC) high power electroencephalographic (EEG) or electrocorticographic (ECoG) events that initiate and terminate suddenly. ECoG recordings of absence seizures in animal models of genetic absence epilepsy show a sudden spike-wave-discharge (SWD) onset that rapidly emerges from normal ECoG activity. However, given that absence seizures occur most often during periods of drowsiness or quiet wakefulness, we wondered whether SWD onset correlates with pre-ictal changes in network activity. To address this, we analyzed ECoG recordings of both spontaneous and induced SWDs in rats with genetic absence epilepsy. We discovered that the duration and intensity of spontaneous SWDs positively correlate with pre-ictal 20-40Hz (?) spectral power and negatively correlate with 4-7Hz (Ø) power. In addition, the output of thalamocortical neurons decreases within the same pre-ictal window of time. In separate experiments we found that the propensity for SWD induction was correlated with pre-ictal ? power. These results argue that CTC networks undergo a pre-seizure state transition, possibly due to a functional reorganization of cortical microcircuits, which leads to the generation of absence seizures.
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Project description:OBJECTIVE:To assess the impact of hypothermic neural rescue at birth on health-related quality of life (HRQL) in middle childhood. DESIGN:Six-year to 7-year follow-up of surviving children from the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) Trial. SETTING:Community study including a single parental questionnaire to collect information on children's HRQL. PATIENTS:145 children (70 in the control group, 75 in the hypothermia group) whose parents consented and returned the questionnaire. INTERVENTIONS:Intensive care with cooling of the body to 33.5°C for 72?hours or intensive care alone. MAIN OUTCOME MEASURES:HRQL attributes and utility scores using the Health Utilities Index (HUI). RESULTS:At 6-7?years, speech appeared disproportionately affected when compared with other aspects of HRQL but levels of normal emotional functioning were similar in both groups. The mean (SE) HUI3 HRQL scores were 0.73 (0.05) in the hypothermia group and 0.62 (0.06) in the control group; mean difference (95% CI) 0.11 (-0.04 to 0.26). CONCLUSIONS:Findings of non-significant differences were not unexpected; the study used data from long-term survivors in a neonatal trial and was underpowered. However, results favoured moderate hypothermia and so complement the clinical results of the TOBY Children study. The work provides further insight into the long-term HRQL impact of perinatal asphyxial encephalopathy and provides previously unavailable utility data with which to contemplate the longer term cost-effectiveness of hypothermic neural rescue. TRIAL REGISTRATION NUMBER:This study reports on the follow-up of the TOBY clinical trial: ClinicalTrials.gov number NCT01092637.
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