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Published on: April 15, 2009
Antecedents of epilepsy and seizures among children born at extremely low gestational age
Rachana Singh1, Laurie M Douglass2, T Michael O'Shea3
1Baystate Children's Hospital, Springfield, MA, USA. Rachana.singhmd@baystatehealth.org.
Insights
Epilepsy in extremely preterm infants is linked to socioeconomic status, maternal fever, and physiological instability. Seizures without epilepsy are associated with placental issues and low oxygen levels shortly after birth.
Area of Science:
- Neonatal Medicine
- Neurology
- Pediatric Epidemiology
Background:
- Epilepsy is a significant concern in extremely preterm infants.
- Understanding specific risk factors is crucial for targeted interventions.
- Distinguishing epilepsy from other seizure types is important for prognosis.
Purpose of the Study:
- To identify distinct risk factors for epilepsy in individuals born extremely preterm.
- To compare risk profiles for epilepsy versus seizures not associated with epilepsy.
Main Methods:
- Prospective cohort study with 10-year follow-up.
- Classification of children into epilepsy, seizures not associated with epilepsy, or no seizures.
- Time-oriented, multinomial logistic regression models to assess perinatal factors.
Main Results:
- Epilepsy (66/888) associated with low socioeconomic status, maternal gestational fever, early physiologic instability, postnatal hydrocortisone, white matter disease, and severe bronchopulmonary dysplasia.
- Seizures not associated with epilepsy (39/888) linked to placental infection/inflammation and early postnatal hypoxemia.
- Distinct risk profiles identified for epilepsy and non-epileptic seizures.
Conclusions:
- Epilepsy and non-epileptic seizures in extremely preterm infants have different risk profiles.
- While both involve infection/inflammation indicators, epilepsy risk factors include more endogenous vulnerabilities.
- Risk stratification can inform preventative strategies for extremely preterm infants.
Objective:
To identify specific risk factors for epilepsy for individuals born extremely preterm.
Study Design:
In a prospective cohort study, at 10-year follow-up, children were classified as having epilepsy or seizures not associated with epilepsy. We evaluated for association of perinatal factors using time-oriented, multinomial logistic regression models.
Results:
Of the 888 children included in the study, 66 had epilepsy and 39 had seizures not associated with epilepsy. Epilepsy was associated with an indicator of low socioeconomic status, maternal gestational fever, early physiologic instability, postnatal exposure to hydrocortisone, cerebral white matter disease and severe bronchopulmonary dysplasia. Seizure without epilepsy was associated with indicators of placental infection and inflammation, and hypoxemia during the first 24 postnatal hours.
Conclusions:
In children born extremely preterm, epilepsy and seizures not associated with epilepsy have different risk profiles. Though both profiles included indicators of infection and inflammation, the profile of risk factors for epilepsy included multiple indicators of endogenous vulnerability.
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