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Seizure recurrence in infants with neonatal convulsions. A follow-up study
J L Gherpelli1, J A Paz, C R Leone
1Department of Neurology, Clinics Hospital of University of São Paulo Medical School, Brasil.
Insights
Neonatal seizures in infants can be managed by discontinuing anticonvulsant medication if neurological exams and EEGs are normal. This approach allows seizure-free outcomes for many infants with neonatal seizures.
Area of Science:
- Neonatal neurology
- Pediatric epilepsy
Background:
- Neonatal seizures affect a significant number of newborns.
- Identifying risk factors and predicting outcomes is crucial for management.
Purpose of the Study:
- To evaluate the long-term outcomes of infants with neonatal seizures.
- To determine predictors of seizure recurrence and inform medication discontinuation strategies.
Main Methods:
- Prospective follow-up of 23 infants with neonatal seizures to a mean age of 11 months.
- Neurological examination, electroencephalogram (EEG), and cranial ultrasonography were performed.
- Anticonvulsant medication was discontinued in cases with normal follow-up assessments.
Main Results:
- Seizure recurrence was observed in 30% (7/23) of infants.
- Abnormal EEG, neurological examination, and cranial ultrasonography findings were statistically correlated with seizure recurrence.
- Hypoxic-ischemic encephalopathy was the most common etiology (82.6%).
Conclusions:
- Infants with neonatal seizures can potentially be weaned off anticonvulsant medication.
- Normal neurological examination, EEG, and cranial ultrasonography are key indicators for successful medication discontinuation.
- These findings support a tailored approach to managing neonatal seizures, prioritizing normal developmental trajectories.
Abstract:
Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEG, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.