Drug-resistant epilepsy in children post-neonatal seizures: Clinical profiles and predictors

To investigate the clinical profile, etiologies, and outcomes of neonatal seizures and identify predictors of drug-resistant epilepsy (DRE) in children.

A retrospective chart review was performed on neonates with seizures admitted to Chiang Mai University Hospital, Thailand, from January 2008 to December 2023. The diagnosis of neonatal seizures was based on clinical findings and/or electroencephalography. Severe impairment refers to limited mobility and minimal speech, while profound impairment indicates being bedridden. DRE is defined as the failure of two antiseizure medications to control seizures.

Among 218 patients (58.3 % male), the median seizure onset was 12 h (interquartile range [IQR]: 2.9-87 h). The leading etiology was perinatal asphyxia (58.7 %), followed by hemorrhage (7.8 %). The median follow-up was 27 months (IQR: 31.5 months). Epilepsy developed in 39 (27.3 %) patients, with 19 (48.7 %) meeting DRE criteria. Risk factors for epilepsy included marked abnormal neuroimaging, refractory neonatal seizures and severe to profound developmental impairment (P <0.05). In the multivariate model, profound developmental impairment (odds ratio [OR] = 2.89, p = 0.04, 95 % confidence interval [CI]: 1.79-24.19) and the development of epileptic spasms or multiple seizure types (OR = 114.80, p = 0.01, 95 % CI: 4.79-2746.07) were identified as an independent risk factor for DRE.

Perinatal asphyxia is the most common cause of neonatal seizures. One-third of neonates with seizures developed epilepsy, with half of them meeting the criteria for DRE. Neonates who develop epileptic spasms, exhibit multiple seizure types, or have profound developmental impairment are key DRE predictors.