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Significance of seizures associated with extracorporeal membrane oxygenation
L R Campbell1, C Bunyapen, M E Gangarosa
1Department of Pediatrics, Medical College of Georgia, Augusta 30912.
Insights
Extracorporeal membrane oxygenation (ECMO) may cause seizures in infants. While short-term seizures during ECMO don't lead to long-term lateralized motor deficits, they are a risk factor for developmental delays.
Area of Science:
- Neonatal neurology
- Pediatric intensive care
- Neurodevelopmental outcomes
Background:
- Infants undergoing extracorporeal membrane oxygenation (ECMO) previously showed a predominance of left focal motor seizures.
- This raised concerns about potential ischemia due to right common carotid artery ligation.
Purpose of the Study:
- To evaluate the neurologic and psychologic outcomes at 2 years of age in infants who experienced ECMO-related seizures.
- To determine if ECMO-related seizures or carotid artery ligation lead to long-term lateralizing motor deficits or developmental impairments.
Main Methods:
- Follow-up assessment of infants who had seizures during ECMO treatment.
- Neurologic examination for motor findings (hemiparesis) and psychologic assessment of developmental quotient at 2 years of age.
Main Results:
- No lateralization of motor findings was observed at 2 years of age, with three infants exhibiting left hemiparesis and three exhibiting right hemiparesis.
- Developmental quotients varied: 6/12 normal, 3/12 low-average, 2/12 borderline, and 1/12 mentally handicapped.
- The majority of infants (8/12) had left focal seizures in infancy.
Conclusions:
- Ischemia from carotid ligation during ECMO is likely insufficient to cause persistent lateralizing motor deficits.
- Seizures occurring during ECMO are identified as a significant risk factor for the development of cerebral palsy or developmental delay later in childhood.
Abstract:
We previously reported a predominance of left focal motor seizures in infants receiving extracorporeal membrane oxygenation (ECMO), raising concerns about possible ischemia resulting from the right common carotid artery ligation. We therefore evaluated the neurologic and psychologic outcome at 2 years of age of all infants with ECMO-related seizures. Although 8 of 12 infants had left focal seizures in infancy, there was no lateralization of motor findings at 2 years of age; left hemiparesis was present in three of the infants and right hemiparesis in three. The developmental quotient was normal in 6 of 12 infants, low-average in three, borderline in two, and in the mentally handicapped range in one. We conclude that any ischemia resulting from carotid ligation is not great enough to produce long-term lateralizing findings but that seizures during ECMO are a risk factor for later cerebral palsy or developmental delay.