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Risk for infantile spasms after acute symptomatic neonatal seizures
Hannah C Glass1,2,3, Zachary M Grinspan4, Yi Li5
1Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
Insights
A new prediction rule accurately identifies neonates at high risk for infantile spasms (IS), a severe early childhood epilepsy. This tool uses EEG, MRI, and clinical data to stratify risk, enabling earlier diagnosis and treatment for better outcomes.
Area of Science:
- Neonatal neurology
- Pediatric epilepsy
- Clinical prediction modeling
Background:
- Infantile spasms (IS) is a severe form of epilepsy in early childhood.
- Early treatment of IS is crucial for seizure remission and optimal developmental outcomes.
- Predicting IS risk in neonates with acute symptomatic seizures is essential for timely intervention.
Purpose of the Study:
- To develop and validate a prediction rule for identifying neonates with acute symptomatic seizures who are likely to develop IS.
- To stratify the risk of IS based on readily available clinical, EEG, and MRI data.
- To aid in clinical counseling and participant selection for clinical trials aimed at preventing post-neonatal epilepsy.
Main Methods:
- Utilized data from the Neonatal Seizure Registry, a prospective, multicenter cohort study.
- Included neonates with acute symptomatic seizures, clinical EEG, MRI, and age under 2 years.
- Employed bivariate analysis and best subsets logistic regression to identify predictors of IS, followed by a consensus process for model selection.
Main Results:
- Infantile spasms (IS) developed in 6% of the 204 infants studied.
- Key predictors identified were: severely abnormal EEG or prolonged seizures on EEG, deep gray or brainstem injury on MRI, and abnormal tone on discharge exam.
- Risk stratification showed 0% IS risk for infants with no factors, 4% with one or two factors, and 57% with all three factors.
Conclusions:
- A risk prediction rule using common clinical data can effectively stratify IS risk in neonates with acute symptomatic seizures.
- The rule identifies a high-risk group (all three factors) with over 50% developing IS, versus 0% in the low-risk group.
- This prediction tool can guide clinical counseling, trial recruitment, and ultimately improve outcomes for infants with this devastating epilepsy.
Objective:
Infantile spasms (IS) is a severe epilepsy in early childhood. Early treatment of IS provides the best chance of seizure remission and favorable developmental outcome. We aimed to develop a prediction rule to accurately predict which neonates with acute symptomatic seizures will develop IS.
Methods:
We used data from the Neonatal Seizure Registry, a prospective, multicenter cohort of infants with acute symptomatic neonatal seizures born from July 2015 to March 2018. Neonates with acute symptomatic seizures who received clinical electroencephalography (EEG) and magnetic resonance imaging (MRI) and were younger than 2 years of age at the time of enrollment were included. We evaluated the association of neonatal EEG, MRI, and clinical factors with subsequent IS using bivariate analysis and best subsets logistic regression. We selected a final model through a consensus process that balanced statistical significance with clinical relevance.
Results:
IS developed in 12 of 204 infants (6%). Multiple potential predictors were associated with IS, including Apgar scores, EEG features, seizure characteristics, MRI abnormalities, and clinical status at hospital discharge. The final model included three risk factors: (a) severely abnormal EEG or ≥3 days with seizures recorded on EEG, (b) deep gray or brainstem injury on MRI, and (c) abnormal tone on discharge exam. The stratified risk of IS was the following: no factors 0% (0/82, 95% confidence interval [CI] 0%-4%), one or two factors 4% (4/108, 95% CI 1%-9%), and all three factors 57% (8/14, 95% CI 29%-83%).
Significance:
IS risk after acute symptomatic neonatal seizures can be stratified using commonly available clinical data. No child without risk factors, vs >50% of those with all three factors, developed IS. This risk prediction rule may be valuable for clinical counseling as well as for selecting participants for clinical trials to prevent post-neonatal epilepsy. This tailored approach may lead to earlier diagnosis and treatment and improve outcomes for a devastating early life epilepsy.
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