EAGLET: EEG vs aEEG to Improve the Diagnosis of neonataL Seizures and Epilepsy

Last updated: August 9, 2023
Sponsor: Cambridge University Hospitals NHS Foundation Trust
Overall Status: Active - Recruiting

Phase

N/A

Condition

Seizure Disorders (Pediatric)

Epilepsy

Treatment

Group B: aEEG with concurrent multichannel (full) continuous cEEG review by clinical neurophysiology

Clinical Study ID

NCT05079971
A 096043
  • Ages > 32
  • All Genders

Study Summary

The current project undertakes a prospective multicentre randomised controlled trial to evaluate whether full or continuous electroencephalography (cEEG) is superior to amplitude-integrated electroencephalography (aEEG) in the real time evaluation and diagnosis of neonatal seizures and in reducing time to treatment. At-risk new-born infants will be recruited on the participating neonatal intensive care units (NICUs) by trained specialist staff and will have 24 hours of EEG monitoring.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Term or preterm neonate, born at post-menstrual age (PMA) 32-44 weeks;
  2. And at least one of the following: (2.1) Neonate with any clinical event suspicious of seizures (2.2) Neonate athigh-risk of seizures with confirmed or suspected: (2.2.1) Hypoxic ischaemicencephalopathy (moderate to severe, or deemed eligible for therapeutic hypothermia) (2.2.2) Cerebral vascular insult (e.g., perinatal arterial ischaemic stroke, cerebralvenous sinus thrombus) (2.2.3) Meningitis / encephalitis - Inflammatory (2.2.4) Inbornerror of metabolism (2.2.5) Brain malformation (2.2.6) Large intraventricularhaemorrhage (III-IV)
  3. Infant is up to 28 days of age
  4. Written informed parental consent can be obtained.

Exclusion

Exclusion Criteria:

  1. No parental consent
  2. Poor prognosis of immediate survival
  3. Any contraindication to perform EEG (e.g. structural pathologies interfering with EEGelectrode placement, such as cephalohematoma or subgaleal haemorrhage).
  4. Infants born at less than 31+6 weeks PMA and infants who are or are suspected to beexperiencing or are at high-risk of seizures when aged 29 days or older.

Study Design

Total Participants: 140
Treatment Group(s): 1
Primary Treatment: Group B: aEEG with concurrent multichannel (full) continuous cEEG review by clinical neurophysiology
Phase:
Study Start date:
July 01, 2023
Estimated Completion Date:
December 31, 2024

Study Description

Seizures are the most common neurological emergency in the neonatal period, affecting over 2000 infants per year in the UK. Although neonatal seizures usually result from acute brain insults, about 10-15% represent genetic forms of epilepsy which are often diagnosed late, thus limiting the timely use of targeted therapies. Lack or delayed initiation of treatment results in a high seizure burden which is independently associated with worse clinical outcomes.

Diagnosing neonatal seizures is challenging because most have only subtle or no clinical manifestation. The gold standard for seizure detection is continuous electroencephalography (cEEG). cEEG can assist with establish the aetiology of seizures, and their management. However, this capability is lacking in most neonatal intensive care units (NICU) due to lack of on-site specialist support. The more common amplitude-integrated EEG (aEEG) uses a limited number of electrodes and is easier to apply and interpret but has been shown to miss a significant number of seizures. It is unclear how often seizure treatment is missed or delayed due to lack of cEEG access. Although studies have compared the diagnostic value of aEEG and cEEG retrospectively, the measured sensitivity of aEEG ranges widely (25-85%), likely due to poor design (retrospective, lack of adequate control group, no power calculations).

The current project undertakes a prospective multicentre randomised controlled trial to evaluate whether cEEG is superior to aEEG in the real time evaluation and diagnosis of neonatal seizures and in reducing time to treatment. At-risk neonates will be recruited on the NICU by trained specialist staff and will have 24 hours of EEG monitoring.

Connect with a study center

  • Cambridge University Hospitals NHS Foundation Trust

    Cambridge,
    United Kingdom

    Active - Recruiting

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