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Seizure Burden and Neurologic Outcomes After Neonatal Encephalopathy
Huda M Alharbi1, Elana F Pinchefsky1, My-An Tran1
1From the Department of Pediatrics (H.M.A.), King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; Department of Pediatrics (E.F.P.), Centre Hospitalier Universitaire Sainte-Justine and the University of Montreal, Quebec; Neurosciences and Mental Health Program (M.-A.T., J.P.V., E.W., C.D.H., E.W.Y.T.), Hospital for Sick Children Research Institute; Department of Paediatrics (C.I.S.C., D.K., E.W., L.L., C.D.H., E.W.Y.T.), Department of Radiology (E.W.), and Department of Psychology (E.M.), The Hospital for Sick Children and the University of Toronto, Ontario, Canada; and Epilepsia Helsinki (P.N.), Department of Clinical Neurophysiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Finland.
Neonatal seizures during encephalopathy are linked to poorer cognitive and language skills later in life. This seizure burden independently impacts development, even after accounting for brain injury and medication.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Clinical Neurology
Background:
- Neonatal encephalopathy (NE) frequently involves seizures, but their impact on long-term outcomes is debated.
- Understanding the contribution of seizure burden (SB) to neurologic outcomes is crucial for NE management.
Purpose of the Study:
- To investigate the association between electrographic seizure burden and neurologic outcomes in infants with NE.
- To determine if seizure burden independently predicts neurodevelopmental outcomes.
Main Methods:
- Prospective cohort study of newborns (≥36 weeks PMA) with NE.
- Continuous electroencephalography (cEEG) for ≥48 hours, brain MRI, and neurodevelopmental assessment at 18 months.
- Multivariable regression adjusted for MRI injury severity and antiseizure medication exposure.
Main Results:
- 21% of infants experienced neonatal seizures.
- Higher total seizure burden was significantly associated with lower cognitive and language scores at 18 months.
- Seizure burden was not significantly linked to epilepsy, neuromotor scores, or cerebral palsy.
Conclusions:
- Increased seizure burden in neonatal encephalopathy independently predicts worse cognitive and language outcomes.
- Neonatal seizures contribute to long-term neurodevelopmental deficits beyond brain injury severity and treatment.
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