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Predictors of acute symptomatic seizures after intracranial hemorrhage in infants
Seema Bansal1, Tewodros Kebede, Nathan P Dean
11Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 2Children's National Medical Center, Washington, DC.
Insights
Infants with supratentorial intracranial hemorrhage have a high risk of acute seizures, even with prophylaxis. Seizures on presentation and parenchymal injury are key risk factors for both acute and late seizures in these infants.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
Background:
- Supratentorial intracranial hemorrhage (ICH) in infants can lead to significant neurological complications.
- Acute symptomatic seizures are a recognized concern in this vulnerable population.
Purpose of the Study:
- To determine the prevalence of acute symptomatic seizures in infants with supratentorial ICH.
- To identify risk factors associated with acute seizures.
- To assess the impact of acute seizures on long-term morbidity and mortality.
Main Methods:
- Retrospective analysis of infants (<24 months) with supratentorial ICH from a neurocritical care database.
- Inclusion criteria: received seizure prophylaxis from admission; exclusion criteria: neonatal ICH, prematurity, prior seizures.
- Risk factors analyzed: gender, etiology, hemorrhage location, presentation seizures, parenchymal injury.
Main Results:
- Forty percent of infants experienced acute symptomatic seizures, irrespective of hemorrhage etiology.
- Independent risk factors for acute seizures included seizures on presentation and parenchymal injury.
- Younger age and female gender were also associated with higher risk; 20% had electrographic-only seizures.
- Acute seizures did not predict mortality but were linked to a nearly twofold increase in late seizures. Electrographic seizures and parenchymal injury predicted late seizures.
Conclusions:
- Infants with supratentorial ICH face a high risk of acute seizures, even with seizure prophylaxis.
- Key predictors for acute seizures include presentation seizures and parenchymal injury.
- These findings underscore the importance of seizure prophylaxis and vigilant monitoring in infants with ICH.
Objective:
To determine the prevalence of acute symptomatic seizures in infants with supratentorial intracranial hemorrhage, to identify potential risk factors, and to determine the effect of acute seizures on long-term morbidity and mortality.
Design:
Children less than 24 months with intracranial hemorrhage were identified from a neurocritical care database. All patients who received seizure prophylaxis beginning at admission were included in the study. Risk factors studied were gender, etiology, location of hemorrhage, seizure(s) on presentation, and the presence of parenchymal injury. Acute clinical and electrographic seizures were identified from hospital medical records. Subsequent development of late seizures was determined based on clinical information from patients' latest follow-up.
Setting And Patients:
Patients with idiopathic neonatal intracranial hemorrhage, premature infants, and those with prior history of seizures were excluded from analysis. Seventy-two infants met inclusion criteria.
Interventions:
None.
Measurements And Main Results:
Forty percent of infants had acute symptomatic seizures. The prevalence was similar regardless of whether etiology of hemorrhage was traumatic or nontraumatic. Seizures on presentation and parenchymal injury were independent risk factors of acute seizures (p = 0.001 and p = 0.006, respectively). Younger children and women were also at higher risk (p < 0.05). Twenty percent had electrographic-only seizures, and those with parenchymal injury trended toward an increased risk (p < 0.1). Acute seizures were not predictive of mortality, but nearly twice as many patients with acute seizures developed late seizures when compared with those without. Electrographic seizures and parenchymal injury were also predictive of development of late seizures (p < 0.001 and p = 0.013, respectively).
Conclusions:
Despite seizure prophylaxis, infants with supratentorial intracranial hemorrhage are at high risk for acute symptomatic seizures. This is regardless of the etiology of hemorrhage. Younger patients, women, patients with parenchymal injury, and patients presenting with seizure are most likely to develop acute seizures. Although the benefits of seizure prophylaxis have not been studied in this specific population, these results suggest that it is an important component of acute care following intracranial hemorrhage.
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