Predicting seizures in babies
Ireland has a unique opportunity to capitalise on its high birth rate and its different strands of research in the perinatal field, writes CLAIRE O'CONNELL
WHEN PROF Geraldine Boylan was expecting her third child, it suddenly struck her that she had made the right move in her work. She was walking around the neonatal intensive care unit at a London hospital, where she was starting a PhD on brainwaves in tiny babies to measure seizures.
“Every day when I was working in the neonatal intensive care unit I realised that while it’s a small minority of children who end up there, it’s not a small minority when it is your child, it’s major,” she recalls.
Boylan, a scientist, had just moved from a clinical neurophysiology job into research with the aim of monitoring what is going on in the brain of a newborn when they are very sick in intensive care – though she is quick to point out that just because a baby is in intensive care does not mean they will have neurological problems.
“A lot of babies in intensive care do fantastically well and they go home and there are no problems,” she says. “We concentrate on a very specific group of babies who have been identified as being at risk of brain injury. They have had problems early on, maybe a lack of oxygen or blood supply to the brain around the time of birth and some of these babies go on to have seizures or ‘fits’.”
Prolonged seizures can be damaging, yet it’s not always obvious from just looking at the baby that one is happening. One way to find out is to monitor the brain using EEG technology. So, in her PhD at King’s College London she decided to use EEG to identify which babies needed help.
“To be honest, moving to research was the best thing I ever did. I always wanted to do something in science that made a difference and I saw this was something I could do,” she says.
“I hoped that by identifying problems earlier that we could help these children get the intervention they needed faster and that in the long term this would improve their outcome.”
Initially the equipment she had to use in the ward was huge, and neonatal units can be quite tight for space. “Back in the 1990s the machines we had were big devices, so it was difficult to do studies of brain monitoring in babies,” says Boylan.
“But we did it because we realised that some babies were having neurological problems. It struck me that in intensive care we were monitoring signals such as heart rate, breathing and blood pressure, but nobody was looking at the brain. So we did some of the first studies of continuous brain monitoring in newborns, and realised just how many seizures a number of these very sick babies were having.”
Boylan, who is originally from Kerry, then moved from London to Cork with her husband and children, and describes how she found a receptive audience in the staff of the neonatal unit at Cork University Maternity Hospital.
“They really understood the importance of research,” she says.
And as luck would have it, she got talking about her plans to an electrical engineer from University College Cork, Dr Liam Marnane.
“I told him I was keen to develop an automated seizure-detection algorithm and I asked if he knew anyone who was into digital signal processing,” she recalls. “I was really amazed when he replied that this was exactly what he did.”
Together with Dr Sean Connolly from St Vincent’s University Hospital Dublin and Prof Tony Ryan from the neonatal unit in Cork, they established a neonatal brain research group and applied for funding through the Health Research Board and Science Foundation Ireland.
The projects have brought clinicians, nurses, scientists and engineers together to tackle the question of how to monitor brain activity in at-risk babies in a way that can make a clinical difference.
And the result is a cot-side system for the intensive care unit that can automatically detect the signs of a seizure and alert nurses and doctors if a problem is brewing.
Parents have been central to the research process, giving consent to the researchers to take the EEG recordings. “I cannot thank them enough,” says Boylan, who is now professor of neonatal physiology at UCC.
The real-time EEG monitoring has already been helping the clinical management of high-risk babies in Cork, and is also being used in an EU-funded project called NEMO to evaluate a potential new anti-seizure medication for newborns in centres across Europe.
The automatic seizure detection system is now set to go even further afield; Boylan and Marnane are now looking to carry out a multicentre clinical evaluation of the seizure-detection system so the technology can ultimately be marketed.
“We are really excited by this,” says Boylan. “We want to see this system in every neonatal intensive care unit in the world.”
The Neonatal Brain Research Group is also working on other perinatal projects with Prof David Henshall at the Royal College of Surgeons in Ireland to look for new anti-seizure therapies for babies and with Prof Louise Kenny in UCC who is analysing risk factors in pregnancy.
“Ireland has a really unique opportunity to be niche in the perinatal research area because of the combination of research that is ongoing and the high birth rate here,” says Boylan.
“We have a very engaged clinical community who really understand that research is important, we have engineers, basic scientists and fantastic neonatal nurses and midwives who participate in research and understand its importance. All the pieces are here.”