Severe neonatal hyperbilirubinemia induces temporal and occipital lobe seizures

Abstract

To examine the origin of seizures induced by severe neonatal hyperbilirubinemia, The EEG characteristics of seizures were analyzed in newborns with and without severe neonatal hyperbilirubinemia. Fisher’s exact test was used to determine the specificity. In total, 931 patients had a total serum bilirubin (TSB) level of 340–425 μmol/L, only 2 of whom had seizures. Compared to patients with hyperbilirubinemia and a TSB level of 340–425 μmol/L, those with a TSB level >425 μmol/L had a significant risk of seizure (OR = 213.2, 95% CI = 113.0–405.8, P<0.001). Of all 28 patients with severe hyperbilirubinemia and seizure, 26 had seizures that originated in the temporal and/or occipital lobe. In seizure patients without severe hyperbilirubinemia, origination in the temporal/occipital and other lobes occurred in 19 and 117 cases, respectively. Compared to the risk of seizure origination in the temporal and/or occipital lobe in other diseases, the risk in patients with severe hyperbilirubinemia was increased by approximately 80 times (OR = 80.1, 95% CI = 28.3–226.4, P<0.001). Severe neonatal hyperbilirubinemia can selectively induce temporal and occipital lobe seizures. This is the first report of a new syndrome with the same etiology and electrophysiological features as epilepsy.

Early Amplitude-Integrated Electroencephalography Predicts Long-Term Outcomes in Term and Near-Term Newborns With Severe Hyperbilirubinemia

“…neurons is not uncommon among newborns with jaundice. [22][23][24][25][26]44 Our results suggest that early severe abnormalities in aEEG recordings are correlated with neurological deficits in newborns with severe jaundice, although its sensitivity was only 35.7%, which was very low compared with abnormal ABR with a sensitivity of 83.3%. One reason for this result might be that ABE might be reversible with rapid and aggressive intervention.…”

“…Bilirubin damages both neurons and astrocytes 3,17 and typically affects the basal ganglia and subthalamus, 3,18,19 which are closely correlated with the electrical activity of cortical neurons. [20][21][22] Previous research using conventional electroencephalography (EEG) has identified diverse abnormal courses of EEG patterns under varying degrees of hyperbilirubinemia in term neonates. 23,24 For example, video EEG in newborns with jaundice clearly predicts the onset of seizures in the temporal and occipital lobes of newborns with total serum bilirubin (TSB) levels greater than 340 mmol/L (17.1 mmol/L ¼ 1 mg/dL of bilirubin; thus 340 mmol/L ¼ 19.9 mg/ dL).…”

“…23,24 For example, video EEG in newborns with jaundice clearly predicts the onset of seizures in the temporal and occipital lobes of newborns with total serum bilirubin (TSB) levels greater than 340 mmol/L (17.1 mmol/L ¼ 1 mg/dL of bilirubin; thus 340 mmol/L ¼ 19.9 mg/ dL). 22 However, studies on the predictive role of aEEG in jaundice patients have yielded conflicting results. 25,26 Here, we report the potential contribution of aEEG to the prediction of prognosis of ABE.…”

Oral fenofibrate for hyperbilirubinemia in term neonates: A single-blind randomized controlled trial

“…Neonatal jaundice can be a leading cause of morbidity if treated improperly [ 2 ]. It can also lead to serious complications such as temporal and occipital lobe seizures in its severe forms [ 3 ], as well as kernicterus and potentially permanent neuro-developmental delay [ 4 ].…”