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Postnatal epilepsy after EEG-confirmed neonatal seizures
1Division of Neurology, Children's Hospital of Philadelphia, PA 19104.
Insights
Neonatal seizures in infants can lead to postnatal epilepsy (PNE). Abnormal EEG backgrounds and cerebral palsy significantly increase PNE risk, impacting long-term outcomes.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Neonatal seizures are a critical concern in infant neurology.
- Understanding the progression to postnatal epilepsy (PNE) is vital for long-term infant health.
- Identifying risk factors for PNE is essential for early intervention.
Purpose of the Study:
- To determine the incidence and types of postnatal epilepsy (PNE) in infants with confirmed neonatal seizures.
- To investigate perinatal and postnatal clinical and EEG variables associated with PNE development.
Main Methods:
- Studied 40 infants with EEG-documented neonatal seizures.
- Followed 27 survivors for a mean of 31 months to assess PNE development.
- Analyzed perinatal factors (coma, gestational age, Apgar scores) and postnatal factors (EEG background, seizure frequency, cerebral palsy, mental retardation).
Main Results:
- Postnatal epilepsy (PNE) developed in 56% of survivors.
- Coma, abnormal EEG backgrounds (68%), and presence of cerebral palsy or mental retardation were significant risk factors for PNE.
- Spikes or sharp waves on postnatal EEGs at 3 months predicted PNE in 100% of cases.
Conclusions:
- Over half of infants with neonatal seizures develop postnatal epilepsy (PNE).
- Abnormal EEG background, cerebral palsy, and specific EEG findings are strong predictors of PNE.
- Early identification of these risk factors is crucial for managing infants at risk of PNE.
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)