Retrospective characterization of seizure semiology and treatment using continuous video-EEG monitoring in neonatal encephalopathy in Uganda

Objective: Neonatal encephalopathy (NE) is a leading cause of childhood death and disability, particularly in sub-Saharan Africa. Detection of NE-related seizures is challenging. We explored NE seizure semiology and management in Uganda. Methods: Video-EEG was recorded (days 1–5), seizure semiology reviewed according to ILAE classification and administration of antiseizure medication (ASM) evaluated. Clinicians treated seizures based on the clinical presentation alone. Results: Among 50 participants, 52% (26) had EEG-confirmed seizures; 70% (18) combined electroclinical/electrographic; 4% (1) exclusively electroclinical; 22% (6) electrographic. Of those with electroclinical seizures (19), 42% displayed >1 semiology. Distribution of seizure semiology was; clonic 34% (11); autonomic 24% (8, of which 6 had prolonged ictal apnea); automatisms 18% (6); behavioral arrest 12% (4); and sequential 12% (4). ASM was administered to 64% (32/50). Of those with EEG-confirmed seizures, only 62% (16/26) received ASM. In the non-seizure group, 38% (9/24) received ASM during monitoring. ASM was administered 42 times, of which 45% (19) were considered appropriate. Significance: In this Ugandan NE population, incidence of seizures was high and clinical manifestations frequent. Clonic, autonomic and automatisms were most common. Clinical management was challenging, with both under and overtreatment evident. Respiratory impairment due to autonomic seizures frequently went unrecognized and is a prominent concern, particularly in settings without neonatal intensive care.