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Neonatal Seizures and Future Epilepsy: Predictive Value of Perinatal Risk Factors, Electroencephalography, and
Tugba Hirfanoglu1, Zeynep Ozturk1, Guntulu Sahin Gokdogan2
1Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey.
Insights
Neonatal seizures can predict future epilepsy. Asphyxia, low Apgar scores, and abnormal EEG/USG findings are key risk factors for developing epilepsy later in life.
Area of Science:
- Neurology
- Neonatal Medicine
- Epileptology
Background:
- Limited data exist on the link between neonatal seizures and later epilepsy development.
- Understanding predictive factors is crucial for early intervention and improved outcomes.
Purpose of the Study:
- To determine the predictive value of perinatal factors, etiologies, electroencephalography (EEG), and cranial ultrasonography (USG) for epilepsy following neonatal seizures.
Main Methods:
- Retrospective evaluation of 92 children with epilepsy and a history of neonatal seizures.
- Analysis of perinatal, natal, and postnatal risk factors using univariate and multivariate logistic regression.
Main Results:
- Epilepsy developed in 57.6% of cases during 1-6 years follow-up.
- Significant predictors included birth weight, Apgar scores, resuscitation history, neurological exam, etiology, treatment response, abnormal EEG, and USG.
- Asphyxia, fifth-minute Apgar scores, treatment response, USG, and EEG were independent predictors.
Conclusions:
- Asphyxia remains a major risk factor for neurological conditions and future epilepsy post-neonatal seizures.
- Apgar scores, multiple antiepileptic drug treatment, poor EEG background, and abnormal neuroimaging strongly predict subsequent epilepsy.
- Close follow-up of infants with neonatal seizures is essential for early epilepsy detection and managing long-term outcomes.
Context:
There are limited data in the literature about the relationship between neonatal seizures and subsequent epilepsy.
Aims:
This study aimed to identify the predictive value of perinatal factors, etiologies, electroencephalography (EEG), and cranial ultrasonography (USG) for future epilepsy after neonatal seizures.
Materials And Methods:
A total of 92 children with epilepsy who had seizures during their neonatal period were retrospectively evaluated whether the contribution of perinatal, natal, and postnatal risk factors confining clinical, laboratory, EEG, and imaging to subsequent epilepsy. Chi-square, uni, and multivariate logistic regression were applied to find out predictive factors for subsequent epilepsy.
Results:
The rate of epilepsy was 57.6 % during 1-6 years follow-up. Birth weight, Apgar scores at first and fifth minutes, resuscitation history, abnormal neurological examination, etiology, response to the treatment, abnormal EEG, or USG findings were the most important risk factors for future epilepsy in univariate analysis (P < 0.05). Furthermore, asphyxia, fifth minute Apgar scores, response to the treatment, USG, and EEG were independent predictors (P < 0.05) for subsequent epilepsy in multivariate logistic regression. No relationship was found between subsequent epilepsy and mode of delivery, seizure onset time, and seizure types (P > 0.05).
Conclusion:
Although there are recent promising and advanced techniques in neonatal intensive care units, asphyxia is still one of the most important risk factors for not only poor neurological conditions but also for future epilepsy after neonatal seizures. Apgar scores, treatment with multiple antiepileptic drugs, poor background EEG activity, and abnormal neuroimaging seem to have strong predictive values for developing subsequent epilepsy. Therefore, patients with a history of neonatal seizures should be closely followed up to decrease the risk of long-term outcomes and early detection of epilepsy.
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