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Epilepsy in very preterm infants: neonatal cranial ultrasound reveals a high-risk subcategory
P N Amess1, J Baudin, J Townsend
1Department of Paediatrics, University College London Medical School, Rayne Institute, UK.
Insights
This study found that preterm infants with epilepsy often have brain injuries like haemorrhagic parenchymal infarction (HPI), suggesting damage beyond typical white matter areas. These infants also experienced greater cognitive impairment.
Area of Science:
- Neonatal neurology
- Pediatric epilepsy
- Neurodevelopmental disorders
Background:
- Perinatal brain injury is a significant risk factor for neurological deficits in preterm infants.
- Epilepsy is a common complication in this population, but the specific injury patterns are not fully understood.
Purpose of the Study:
- To investigate the association between specific types of perinatal brain injury and the development of epilepsy in preterm infants (<33 weeks' gestation).
- To explore the relationship between brain lesions, epilepsy, and cognitive outcomes in this cohort.
Main Methods:
- A cohort of 610 preterm infants (<33 weeks' gestation) was studied.
- Epilepsy diagnosis was determined via postal questionnaire.
- Cranial ultrasound findings were analyzed, focusing on high-risk lesions such as haemorrhagic parenchymal infarction (HPI) and cystic periventricular leukomalacia (PVL).
- Cognitive impairment was assessed in children with and without epilepsy.
Main Results:
- The prevalence of epilepsy was 4.3% in the cohort.
- Most children with epilepsy (16/24) had high-risk cranial ultrasound lesions.
- Children with epilepsy were more likely to have HPI and less likely to have cystic PVL compared to those without epilepsy.
- Epilepsy and high-risk lesions were associated with greater cognitive impairment, suggesting more extensive cortical grey-matter damage.
Conclusions:
- Perinatal brain injury, particularly HPI, is strongly associated with epilepsy in preterm infants.
- The findings suggest that brain injury in preterm infants with epilepsy may extend beyond the periventricular white matter into cortical areas.
- Early identification of specific brain injury patterns may aid in predicting epilepsy risk and cognitive outcomes.
Abstract:
The aim of this study was to investigate the association between epilepsy and perinatal brain injury in a cohort of 610 infants born preterm at <33 weeks' gestation. The prevalence of epilepsy in this cohort was 4.3% as determined by a postal questionnaire survey. Most children with epilepsy (16 of 24) had high-risk cranial ultrasound lesions including haemorrhagic parenchymal infarction (HPI), posthaemorrhagic hydrocephalus, and cystic periventricular leukomalacia (PVL). Of all the children in our cohort with high-risk brain lesions, those with epilepsy were more likely to have HPI and significantly less likely to have cystic PVL, although it is possible that PVL was not noticed in some cases. Children with epilepsy and high-risk cranial ultrasound lesions also showed more cognitive impairment than children with high-risk lesions but no epilepsy, which suggested more cortical grey-matter damage. We suggest that brain injury has occurred outside the confines of the periventricular white matter in this group of preterm infants with epilepsy.