Relationship of Neonatal Seizure Burden Before Treatment and Response to Initial Antiseizure Medication

Area of Science:

• Neonatal Neurology
• Neurophysiology
• Clinical Neuropharmacology

Background:

• Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal brain injury.
• Seizures are common in neonates with HIE and require prompt treatment.
• Predicting response to antiseizure medications (ASMs) is crucial for effective HIE management.

Purpose of the Study:

• To investigate the association between pretreatment seizure burden and total seizure duration with initial ASM treatment success in neonates with HIE.
• To determine if maximal hourly seizure burden is a better predictor of ASM response than total seizure duration.

Main Methods:

• Retrospective review of neonates with moderate-to-severe HIE and acute symptomatic seizures from the HEAL Trial.
• Continuous electroencephalogram (EEG) monitoring to quantify seizure burden and duration.
• Poisson regression analysis to assess associations between seizure parameters and successful initial ASM response.

Main Results:

• Greater pretreatment maximal hourly seizure burden was associated with a lower likelihood of successful initial ASM response (aRR 0.83 per 5-min increase).
• No significant association was found between pretreatment total seizure duration and successful ASM response.
• Shorter time-to-treatment was paradoxically linked to a slightly lower chance of successful response.

Conclusions:

• Maximal hourly seizure burden is a significant predictor of initial ASM treatment success in neonates with HIE.
• This metric may be more clinically relevant than total seizure duration for guiding acute seizure management.
• Further research is warranted to optimize ASM selection based on seizure burden characteristics.