Source:Pediatric Neurology
Author(s): Hannah C. Glass, Adam L. Numis, Dawn Gano, Varun Bali, Elizabeth E. Rogers
BackgroundNeonatal seizures due to acute brain injury are associated with high rates of death, disability and epilepsy. Our objective was to examine incidence of and risk factors for epilepsy among survivors of acute symptomatic neonatal seizures who were cared for by a Neonatal Neurocritical Care Service.MethodsNeonates with acute symptomatic seizures who were admitted to UCSF Benioff Children's Hospital Neuro-Intensive Care Nursery from 7/2008-6/2014 were considered for inclusion.Results144 children with acute symptomatic seizures met study criteria and 37 (26%) died before age 1. Eighty-seven children (85% of eligible survivors) were followed to >1 year. Epilepsy was diagnosed in 8 at median age 4.9 (IQR 1.7, 6.1) years. The cumulative incidence risk of epilepsy at one year was 2% (95% CI 0.6%-9%) and at 5 years was 7% (95% CI 3%-20%). Cerebral palsy was diagnosed in 21%. Bayley-III cognitive subscale <85 was present in 13%. Children with epilepsy were more likely to be preterm, have brain injury and be discharged home on anti-seizure medication.ConclusionsRisk of epilepsy was lower and age at onset older than previous reports, which may be due to multiple factors including a neurocritical care approach, treatment of HIE with hypothermia, high rate of neonatal transition to palliative care, and exclusion of neonatal onset epilepsies. Continuation of anti-seizure medications in infancy did not decrease the risk of epilepsy. Long term, multicenter studies are needed to understand whether neonatal seizure management can alter the risk of epilepsy.
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