Postnatal Epilepsy After EEG‐Confirmed Neonatal Seizures

Abstract

We examined infants whose neonatal seizures were confirmed by randomly recorded ictal EEG tracings to determine the types and frequency of postnatal epilepsy (PNE)--unprovoked, recurring postnatal seizures. Perinatal and postnatal clinical and EEG variables were also examined for their relevance to PNE. Forty infants with EEG-documented neonatal seizures of diverse etiologies were studied. The 27 survivors were followed for a mean of 31 months. PNE developed in 56% (15 of 27) of the cohort. The first seizure appeared at a mean-corrected age of 12.7 months and occurred despite ongoing antiepileptic medication in 60% (9 of 15) of the group. Seizures were classified as infantile spasms or minor motor (7 patients), complex partial (4 patients), or generalized tonic-clonic (4 patients). Perinatal variables that significantly correlated with PNE included the presence of coma but not the age at seizure onset, the estimated gestational age, or Apgar scores. PNE occurred in 68% (13 of 19) of patients with moderately or markedly abnormal EEG backgrounds but in only 25% (2 of 8) without (p = 0.035). There was a strong trend for PNE to develop in patients with greater than 10 electrographic seizures per hour but in only 45% (9 of 20) of infants with fewer seizures (p = 0.058). Several postnatal variables were significantly related to PNE--the presence of cerebral palsy (CP), mental retardation (MR), CP with MR, and follow-up EEGs. PNE occurred in only 27% (3 of 11) of patients without spikes or sharp waves on postnatal EEGs performed at age 3 months but in 100% (3 of 3) of patients with spikes or sharp waves (p = 0.022).(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal seizures and postneonatal epilepsy: a 7-y follow-up study

“…16). Increasing availability of amplitude-integrated EEG in monitoring neonates with seizures (11,17) and differences in ascertainment (prospective vs. retrospective studies) might account for some of the differences in results (7,18). A rate of 9.5% of postneonatal epilepsy has been reported in studies using amplitudeintegrated EEG (11) and higher rates were seen in hospitalbased studies where the seizures were EEG-confirmed (41.4 to 56%; refs.…”

“…However, published data on the magnitude of the risk of developing postneonatal epilepsy and predisposing factors present considerable variability mainly due to small sample size of some studies, inclusion of newborns with seizures detected only clinically, and short follow-up duration (3,7,8). We attempted to address this gap by evaluating the frequency of postneonatal epilepsy at 7 y of age in a group of patients who presented video-electroencephalogram (EEG)-confirmed neonatal seizures and evaluated the clinical, EEG, and cerebral ultrasound (US) findings associated with the development of epilepsy.…”

Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial

“…Other studies have revealed that infants treated for clinical and electrographic seizures had a lower incidence of postneonatal epilepsy, compared with historical controls treated only for clinical seizures. 14,[18][19][20][21] This study reveals the first randomized controlled trial (RCT) evaluating the impact of treatment of electrographic seizures using continuous cEEG video for monitoring and targeted treatment of electrographic seizures in HIE.…”

Acute and Chronic Effects of Seizures in the Developing Brain: Lessons from Clinical Experience

“…The findings of more recent studies vary, depending on the characteristics of the populations studied, inclusion criteria, and methodology of data analysis. The occurrence of neurologic impairment ranged from 3 1 to 49%, with the most determining factor being the degree and distribution in the brain (78)(79)(80).…”