Dr Ronit Pressler is Consultant in Clinical Neurophysiology at Great Ormond
Street Hospital for Children and Associate Professor at the UCL-GOS Institute of
Child Health, London. She currently serves as Honorary secretary at BSCN. She
has been chairing a number of neonatal task forces and working groups
including the ILAE neonatal seizure classification task force and the neonatal
guidelines update task force. She is Associate Editor at Epilepsia Open. Her
research interests are neonatal seizures, particularly their diagnosis and treatment, as well as the pre-surgical evaluation in children with complex epilepsy.

Neonatal EEG is one of the few objective methods measuring the functional integrity of the immature cortex and its connections. It can assist in determining brain maturation, evaluate acute neonatal brain injury and diagnosing seizures. While the principles of electroencephalography are the same in neonates as in older children and adults, successfully recording and interpreting neonatal EEGs requires specialized skills. In particular, good knowledge of the normal EEG maturation is essential as well as understanding clinical details, such as the corrected gestational age and the clinical state of the newborn.
Abnormalities of the background may indicate diagnosis, grading and prognosis in brain injury of preterm infants (such as intraventricular haemorrhage and PVL) and term infants (such as hypoxic ischemic encephalopathy, meningoencephalitis and stroke).
Seizures are the most common neurological emergency in the neonataL period but are most often acute provoked due to hypoxic ischemic encephalopathy or stroke. The clinical diagnosis of seizures is challenging because most have no or only discreet clinical manifestation thus EEG is essential for diagnosis. Depending on the aetiology, up to 60% of seizures are electrographic-only, mostly in critically ill infants, and after treatment with some anti-seizure medication (uncoupling).
Electrographic seizures are defined as a paroxysmal abnormal, sustained change in the EEG with a repetitive and evolving pattern with a minimum 2 μV voltage (peak to peak) and duration of at least 10 seconds (ACNS, 2013). Seizure onset in neonates is focal or multifocal and involved smaller regions of onset and remained localised in preterm infants. The new ILAE classification for seizures in the neonate uses the same framework and terminology as the 2017 ILAE seizure classification (Fisher et al 2017, Scheffer et al 2017), but is tailored towards neonates. Seizures types include motor events (automatisms, clonic, epileptic spasms, myoclonic, sequential, tonic) or non-motor events (autonomic, behavior arrest) or be electro-graphic only.