Courtney J Wusthoff

• MD
• University of California, Davis

The development of clinical practice guidelines is an evolving field. In response to the need for consistent, evidence-based medical practice, the American Clinical Neurophysiology Society identified the need to update the Society's guideline development process. The American Clinical Neurophysiology Society Guidelines Committee created an action p...

Importance Outcomes after hypoxic-ischemic encephalopathy (HIE) are variable. Predicting death or severe neurodevelopmental impairment (NDI) in affected neonates is crucial for guiding management and parent communication. Objective To predict death or severe NDI in neonates who receive hypothermia for HIE. Design, Setting, and Participants This p...

Objective To review the available literature concerning the definition of neonatal status epilepticus (SE) and/or seizure burden. Methods The International League Against Epilepsy Neonatal Task Force performed a scoping review of the definitions of neonatal SE. Following a systematic literature review, articles were screened and data were abstract...

Purpose Continuous EEG (cEEG) monitoring is increasingly used in the management of neonates with seizures. There remains debate on what clinically relevant information can be gained from cEEG in neonates with suspected seizures, at high risk for seizures, or with definite seizures, as well as the use of cEEG for prognosis in a variety of conditions...

Neonates with congenital heart disease (CHD) are at risk for adverse neurodevelopmental outcomes. This scoping review summarizes neuromonitoring methods in neonates with CHD. We identified 84 studies investigating the use of near-infrared spectroscopy (NIRS) ( n = 37), electroencephalography (EEG) ( n = 20), amplitude-integrated electroencephalogra...

Background ‘Neonatal encephalopathy’ (NE) describes a group of conditions in term infants presenting in the earliest days after birth with disturbed neurological function of cerebral origin. NE is aetiologically heterogenous; one cause is peripartum hypoxic ischaemia. Lack of uniformity in the terminology used to describe NE and its diagnostic crit...

Neonates are susceptible to seizures due to their unique physiology and combination of risks associated with gestation, delivery, and the immediate postnatal period. Advances in neonatal care have improved outcomes for some of our most fragile patients, but there are persistent challenges for epileptologists in identifying neonatal seizures, diagno...

The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-ter...

Background and Objectives Predicting neurodevelopmental outcome for neonates with hypoxic-ischemic encephalopathy (HIE) is important for clinical decision-making, care planning, and parent communication. We examined the relationship between EEG background and neurodevelopmental outcome among children enrolled in a trial of erythropoietin (Epo) or p...

Purpose: To examine the association between CEEG use and discharge status, length of hospitalization, and health care cost in a critically ill pediatric population. Methods: Four thousand three hundred forty-eight critically ill children were identified from a US nationwide administrative health claims database; 212 (4.9%) of whom underwent CEEG...

Objectives To assess variability in continuation of antiseizure medication (ASM) at discharge and to evaluate if continuation of ASM at discharge is associated with death or disability among infants with hypoxic-ischaemic encephalopathy (HIE) and seizures. Design Retrospective study of infants enrolled in three National Institute of Child Health a...

Introduction Scalp high-frequency oscillations (HFOs, 80–250 Hz) are increasingly recognized as EEG markers of epileptic brain activity. It is, however, unclear what level of brain maturity is necessary to generate these oscillations. Many studies have reported the occurrence of scalp HFOs in children with a correlation between treatment success of...

Objective Among neonates with acute symptomatic seizures, we evaluated whether the inability to take full feeds at the time of hospital discharge from neonatal seizure admission is associated with worse neurodevelopmental outcomes, after adjusting for relevant clinical variables. Methods This prospective, nine‐center study of the Neonatal Seizure...

Background: An ancillary study of the High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial for neonates with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia examined the hypothesis that neonates randomized to receive erythropoietin (Epo) would have a lower seizure risk and burden compared with neonat...

The blooming of neonatal neurocritical care over the last decade reflects substantial advances in neuromonitoring and neuroprotection. The most commonly used brain monitoring tools in the neonatal intensive care unit (NICU) are amplitude integrated EEG (aEEG), full multichannel continuous EEG (cEEG), and near-infrared spectroscopy (NIRS). While som...

Neonatal intensive care has expanded from cardiorespiratory care to a holistic approach emphasizing brain health. To best understand and monitor brain function and physiology in the neonatal intensive care unit (NICU), the most commonly used tools are amplitude-integrated EEG, full multichannel continuous EEG, and near-infrared spectroscopy. Each o...

Outcomes of neonatal encephalopathy (NE) have improved since the widespread implementation of therapeutic hypothermia (TH) in high-resource settings. While TH for NE in term and near-term infants has proven beneficial, 30–50% of infants with moderate-to-severe NE treated with TH still suffer death or significant impairments. There is therefore a cr...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for...

Electroencephalography (EEG) is a neurologic monitoring modality that allows for the identification of seizures and the understanding of cerebral function. Not only can EEG data provide real-time information about a patient’s clinical status, but providers are increasingly using these results to understand short and long-term prognosis in critical...

Objective To characterize association between seizure burden, electroencephalogram(EEG) background, and neurodevelopmental outcome among neonates with acute symptomatic seizures due to intracranial infection. Methods This secondary analysis was from a prospective, multicenter study of neonates enrolled in the Neonatal Seizure Registry with seizure...

Objective: To determine whether selection of treatment for children with infantile spasms (IS) varies by race/ethnicity. Methods: The prospective US National Infantile Spasms Consortium database includes children with IS treated from 2012-2018. We examined the relationship between race/ethnicity and receipt of standard IS therapy (prednisolone,...

Background: Hypoglycemic coma (HC) is an uncommon but severe clinical condition associated with poor neurological outcome. There is a dearth of robust neurological prognostic factors after HC. On the other hand, there is an increasing body of literature on reliable prognostic markers in the postanoxic coma, a similar-albeit not identical-situation...

Background and Objective Children with a history of acute provoked neonatal seizures are at high risk for disability, often requiring developmental services. The COVID-19 pandemic has led to widespread changes in how healthcare is delivered. Our objective was to determine the magnitude of service interruption of services among children born between...

Because a genetic diagnosis can guide clinical management and improve prognosis in critically ill patients, much effort has gone into developing methods that result in rapid, reliable results. The authors describe extremely rapid sequencing and analysis of the genomes of 12 patients, 5 of whom received a diagnosis.

Little is known about parent and family well-being after acute neonatal seizures. In thus study, we aimed to characterize parent mental health and family coping over the first two years after their child’s neonatal seizures. Parents of 303 children with acute neonatal seizures from nine pediatric hospitals completed surveys at discharge and 12-, 18...

Continuous EEG (cEEG) is a fundamental neurodiagnostic tool in the care of critically ill neonates and is increasingly recommended. cEEG enhances prognostication via assessment of the background brain activity, plays a role in predicting which neonates are at risk for seizures when combined with clinical factors, and allows for accurate diagnosis a...

Objective To characterize intracranial hemorrhage (ICH) as a seizure etiology in infants born at term and preterm. For term infants, to compare seizure severity and treatment response for multi-site vs single-site ICH and hypoxic-ischemic encephalopathy (HIE) with vs. without ICH. Study design We studied 112 newborn infants with seizures attribute...

Objective To compare key seizure and outcome characteristics between neonates with and without cardiopulmonary disease (CPD). Study design The Neonatal Seizure Registry (NSR-1) is a multicenter, prospectively acquired cohort of neonates with clinical or EEG-confirmed seizures. CPD was defined as congenital heart disease, congenital diaphragmatic h...

Neonatal encephalopathy (NE) is the most common etiology of acute neonatal seizures - about half of neonates treated with therapeutic hypothermia for NE have EEG-confirmed seizures. These seizures are best identified with continuous EEG monitoring, as clinical diagnosis leads to under-diagnosis of subclinical seizures and over-treatment of events t...

Neonatal neurocritical care (NNCC) is a rapidly advancing field with limited fellowship training available in locally developed, non-accredited programs. A standardized survey aimed to understand the training backgrounds of individuals practicing NNCC, the structure of existing clinical NNCC services/training programs, and suggested clinical compet...

Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that may result from a variety of etiologies. HIE should be distinguished from neonatal encephalopathy due to other causes using data gathered from the history, physical and neurological exam, and further investigations. Identifying the underlying...

Background Guidelines recommend evaluation for electrographic seizures in neonates and children at risk, including after cardiopulmonary bypass (CPB). Although initial research using screening electroencephalograms (EEGs) in infants after CPB found a 21% seizure incidence, more recent work reports seizure incidences ranging 3–12%. Deep hypothermic...

Objective Compare the effectiveness of initial treatment for infantile spasms. Methods The National Infantile Spasms Consortium prospectively followed children with new onset infantile spasms that began at age 2-24 months at 23 US centers (2012-2018). Freedom from treatment failure at 60 days required no second treatment for infantile spasms and n...

Objective We aimed to evaluate early‐life epilepsy incidence, seizure types, severity, risk factors, and treatments among survivors of acute neonatal seizures. Methods Neonates with acute symptomatic seizures born 7/2015‐3/2018 were prospectively enrolled at nine Neonatal Seizure Registry sites. One‐hour EEG was recorded at age three months. Post‐...

Purpose Parents of neonates with seizures are at risk of mental health symptoms due to the impact of illness on family life, prognostic uncertainty, and the emotional toll of hospitalization. A family-centered approach is the preferred model to mitigate these challenges. We aimed to identify strategies to promote family-centered care through an ana...

Objective To determine whether screening continuous EEG monitoring (cEEG) is associated with greater odds of treatment success for neonatal seizures. Methods We included term neonates with acute symptomatic seizures enrolled in the Neonatal Seizure Registry (NSR) , a prospective, multicenter cohort of neonates with seizures. We compared two cEEG a...

Engaging with ethical issues is central to the management of neonatal encephalopathy (NE). As treatment for these neonates evolves, new ethical issues will arise and many existing challenges will remain. We highlight three key ethical issues that arise in the care of neonates with NE treated with therapeutic hypothermia: facilitating shared decisio...

Importance Antiseizure medication (ASM) treatment duration for acute symptomatic neonatal seizures is variable. A randomized clinical trial of phenobarbital compared with placebo after resolution of acute symptomatic seizures closed early owing to low enrollment. Objective To assess whether ASM discontinuation after resolution of acute symptomatic...

Neonatal seizures present a unique diagnostic challenge with clinical manifestations often subtle or absent to the bedside observer. Seizures can be overdiagnosed in newborns with unusual paroxysmal movements and underdiagnosed in newborns without clinical signs of seizures. Electroclinical “uncoupling” also adds to diagnostic challenge. Reliable d...

Objective The aim of the study is to model amplitude-integrated electroencephalography (aEEG) utility to diagnose seizures in common clinical scenarios. Study Design Using reported neonatal seizure prevalence and aEEG sensitivities and specificities, likelihood ratios (LRs) and post-test probabilities were calculated to quantify aEEG utility to dia...

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deploym...

White matter undergoes rapid development in the neonatal period. Its structure during and after development is influenced by neuronal activity. Pathological neuronal activity, as in seizures, might alter white matter, which in turn may contribute to network dysfunction. Neonatal epilepsy presents an opportunity to investigate seizures and early whi...

Background Neonatal seizures are associated with death and neurologic morbidity; however, little is known about how neonates with seizures die. Methods This was a prospective, observational cohort study of neonates with seizures treated at seven sites of the Neonatal Seizure Registry. We characterized mode of death, evaluated the association betwe...

This proposal is for a multi-centre collaborative clinical study to reconsider and further refine the criteria of full-term neonatal encephalopathy initially defined in 1976 by Sarnat and Sarnat. Its suggestions are intended as a template for prospective study to be followed by clinical application. Precise criteria and good inter-observer reliabil...

Objective Neonates with seizures have a high risk of mortality and neurological morbidity. We aimed to describe the experience of parents caring for neonates with seizures. Design This prospective, observational and multicentre ( Neonatal Seizure Registry ) study enrolled parents of neonates with acute symptomatic seizures. At the time of hospital...

Objective To characterize and determine risk factors for key dimensions of well-being at hospital discharge in families of neonates with acute symptomatic seizures. Study design This prospective, observational cohort study enrolled 144 parent-infant dyads among neonates with acute symptomatic seizures from 9 pediatric hospitals in the Neonatal Sei...

Pediatric neurology patients frequently use integrative medicine; however, providers may feel uncomfortable or unfamiliar with these therapies. Child neurologist attitudes toward integrative medicine and educational needs in integrative medicine have not been assessed. A national, anonymous survey was distributed to Child Neurology residents (n=294...

Objective. To understand pediatric residents’ experiences and attitudes toward learning neurology; and to identify facilitators and barriers to learning neurology during residency. Study Design. Qualitative study using focus groups of pediatric residents at Stanford during November 2017. Focus groups were audio-recorded and transcribed verbatim. In...

Rationale: Early-life epilepsies (ELEs) include some of the most challenging forms of epilepsy to manage. Given recent diagnostic and therapeutic advances, a contemporary assessment of the immediate short-term outcomes can provide a valuable framework for identifying priorities and benchmarks for evaluating quality improvement efforts. Methods:...

Background: The Induced Hypothermia (IH) and Optimizing Cooling (OC) trials for hypoxic-ischemic encephalopathy (HIE) had similar inclusion criteria. The rate of death/moderate-severe disability differed for the subgroups treated with therapeutic hypothermia (TH) at 33.5 °C for 72 h (44% vs. 29%, unadjusted p = 0.03). We aimed to evaluate differen...

In a prospective cohort of 534 neonates with acute symptomatic seizures, 66% had incomplete response to the initial loading dose of antiseizure medication (ASM). Treatment response did not differ by gestational age, sex, medication, or dose. The risk of incomplete response was highest for seizures due to intracranial hemorrhage and lowest for hypox...

Management of seizures during the neonatal period can be challenging, with the unique features of neonatal physiology affecting considerations for many of the antiepileptic drugs (AEDs) commonly used for older children and adults. High-quality evidence in neonates is lacking for many of these treatments, with use of many drugs based on historical p...

Background: Infantile spasms (IS) is a neurologic disorder of childhood where time to treatment may affect long-term outcomes. Due to the clinical complexity of IS, care can be delayed. Objective: To determine if the use of electronic medical record templates (EMRTs) improved care quality in patients treated for IS. Method: Records of patients...

Objectives: We assessed the adherence to neuroimaging guidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). Methods: There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) an...

Objective Many critically ill neonates have an existing brain injury or are at risk of neurologic injury. We developed a “NeuroNICU” (neurologic neonatal intensive care unit) to better provide neurologically focused intensive care. Study Design Demographic and clinical variables, services delivered, and patient outcomes were recorded in a prospecti...

Infantile spasms are the defining seizures of West syndrome, a severe form of early life epilepsy with poorly-understood pathophysiology. We present a novel comparative analysis of infants with spasms versus other seizure-types and identify clinical, etiological, and molecular-genetic factors preferentially predisposing to spasms. We compared ages,...

Evaluations performed in infants with and without spasms. (DOCX)

epiSEEK® comprehensive sequence analysis of epilepsy and seizure disorders (471 genes). (DOCX)

List of genes with pathogenic variants and their association with spasms. (DOCX)

Significant enriched gene sets of pathways, cellular compartments and molecular functions and corresponding descriptions, analyses statistical values, and compiled categories, from the mSigDB gene ontology-pathway (GO-pathway) analysis. (DOCX)

Importance More than half of infants with new-onset epilepsy have electroencephalographic and clinical features that do not conform to known electroclinical syndromes (ie, nonsyndromic epilepsy). Levetiracetam and phenobarbital are the most commonly prescribed medications for epilepsy in infants, but their comparative effectiveness is unknown. Obj...

Objective: Although hospitals increasingly offer therapeutic hypothermia (TH), there is variable implementation of related services. We assessed current practices and opinions regarding what services should be required of centers providing TH in California. Study design: We surveyed neonatal intensive care unit physicians statewide regarding pra...