Seizure-associated brain injury in term newborns with perinatal asphyxia
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To the Editor:
The recent article by Miller et al.1 explores the important area of neonatal asphyxia and seizures using 1H-MRS markers of neuronal metabolism and integrity. The authors indeed found changes in basal nuclei lactate/choline ratios and intervascular boundary zone lactate/choline and N-acetyl aspartate (NAA)/choline ratios suggesting that neonatal seizures alter brain metabolism and neuronal integrity.
The authors have created and applied as their main predictor variable for seizure severity a “seizure score” consisting of four scores relating to seizure frequency, seizure onset, EEG characteristics, and anticonvulsant therapy. There is no reference to prior use of the score and the design, application, and analytical issues related to the development of the score that should be of concern to the reader are not addressed in the article.
Such scores may be a source of powerful information, but choosing the factors that contribute to the content and construct validity of this type of score can be difficult.2 In the development of this score, it is not clear why items such as seizure type, seizure duration, and a more detailed frequency score were included. In addition, it is unclear on what basis a difference in seizure onset of 24 hours has been given a 10% difference in seizure “severity.” Individual subscales of a score must contribute individually to the overall score without substantial overlap in information.3 In this situation, the factors impacting severity have questionable independence and may not …
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