Comparative clinical study of preterm and full-term newborn neonatal seizures

Holanda, Manoel Reginaldo Rocha de; Melo, Alan Peres Ferraz de

doi:10.1590/s0004-282x2006000100010

Cited by 24 publications

(20 citation statements)

References 26 publications

(9 reference statements)

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“…However, in this study, we observed a predominance of seizures in term newborns with birth weight adequate to gestational age. These results agree with a previous cohort followed in our institution and with another study from the same country 9,20 . This finding might be related to regional peculiarities of maternal and birth care or perhaps due to the high incidence of perinatal asphyxia in our cohort.…”

Section: Discussionsupporting

confidence: 94%

“…However, this equipment is not always available in many neonatal units around the world. Critics for over-diagnosing or misdiagnosing seizures using only clinical criteria have been pointed by many authors 1,3,5,9,16,19,20,32,33 . As described in methodology, we have used a very restrict criteria to diagnose clinical seizures and furthermore all the patients included in the study were prospectively followed in the neonatal unit since the suspicion of seizures.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, to be included in the study the newborns should have had at least two clinically proven episodes of seizures seen by the Neonatologist or Child Neurologist after maneuvers to attempt to restrain spontaneous events and to provoke events with tactile stimulation were performed 19,20 .…”

Section: Methodsmentioning

confidence: 99%

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Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital

Nunes

Martins

Barea

et al. 2008

Arq. Neuro-Psiquiatr.

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-Objective: To describe the neurological outcome of newborns with seizures. Method: Cohort study with newborns prospectively followed. Perinatal characteristics and etiological screening were related to outcome in a regression model. Results: During the study 3659 newborns were admitted and 2.7% were diagnosed as having seizures. Hypoxic ischemic encephalopathy (51%) was the etiology more frequently associated to seizures and also to postneonatal epilepsy (53%). In the follow up 25 died during the acute neonatal illness and 9 during the first years of life, 19 were diagnosed as having post neonatal epilepsy, 35 had developmental delay and 11 an association among this two comorbidities. A significant association between abnormal postnatal EEG and neuroimaging to developmental delay (p=0.014, p=0.026) was observed. The group of newborns that had seizures presented an increased risk of developing epilepsy compared to newborns from the same cohort without seizures (19.3/100 vs. 1.8/100, p<0.001). Conclusion: In this study neonatal seizures predominated in term newborns with perinatal asphyxia an elevated perinatal mortality and post neonatal morbidity was observed.The follow up showed an increased risk for developing postnatal epilepsy and developmental delay.KEy worDs: neonatal seizures, follow up, epilepsy, neonatal EEG, preterm newborn. Prognóstico neurológico de recém nascidos com crises convulsivas: estudo de coorte em hospital terciárioResumo -Objetivo: Avaliar o prognóstico neurológico de neonatos com crises convulsivas. Método: Estudo prospectivo, realizado em coorte de neonatos provenientes de hospital terciário. As características clínicas perinatais e os resultados de exames complementares foram correlacionados com prognóstico através de modelo de regressão logística. Resultados: Durante o estudo 3659 neonatos foram internados, sendo que 101 apresentaram crises convulsivas (2,7%). A encefalopatia hipóxico-isquêmica foi a etiologia mais frequentemente associada às crises (51%). o seguimento evidenciou 25 óbitos no período neonatal e 9 durante os primeiros anos de vida, 19 lactentes desenvolveram epilepsia, 35 atraso no desenvolvimento e 11 associação entre os dois desfechos. o modelo de regressão logística aplicado mostrou associação significativa entre EEG pós neonatal anormal e neuroimagem anormal com atraso no desenvolvimento (p=0,014, p=0,026). os neonatos em estudo, quando comparados aos demais da mesma coorte, que não apresentaram crises convulsivas tiveram maior probabilidade de desenvolver epilepsia (19,3/100 vs. 1,8/100, p<0,001). Conclusão: Neste estudo em que ocorreu predomínio de crises neonatais em neonatos a termo com asfixia perinatal, foi observada alta mortalidade perinatal e morbidade. o seguimento neurológico evidenciou elevado risco de desenvolvimento de epilepsia e/ou atraso no desenvolvimento neuropsicomotor.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital

Nunes

Martins

Barea

et al. 2008

Arq. Neuro-Psiquiatr.

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“…Previous studies that analyzed this relationship were not necessarily based on simultaneous EEG confirmation of the seizures or did not express, case by case, the electroclinical aspects of the ictal seizure …”

Section: Introductionmentioning

confidence: 99%

Neonatal seizures: Is there a relationship between ictal electroclinical features and etiology? A critical appraisal based on a systematic literature review

et al. 2019

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Summary The aim of this study was to evaluate whether specific etiologies of neonatal seizures have distinct ictal electroclinical features. A systematic review of English articles using the PubMed database since 2004 (last update 9/26/16). Search terms included text words and Medical Subject Headings (MeSH) terms related to neonatal seizures. Eligible articles included reports of neonates with seizures with a full description of seizure semiology and electroclinical findings. Independent extraction of data was performed by 2 authors using predefined data fields, including study quality indicators. Data were collected for every individual patient described in the articles. The dataset was analyzed with the Fisher exact test. The initial search led to 8507 titles; using filters, 2910 titles and abstracts were identified, with 177 full texts selected to be read. Fifty‐seven studies were included in the analysis with 151 neonates (37.7 male and 62.9% term). Genetic etiologies (51%) and sequential seizures (41.1%) predominated in this sample and hypoxic‐ischemic encephalopathy (HIE) accounted for only 4%. The low prevalence of HIE observed was probably due to a publication bias. A significant association was found between etiology and seizure type: hemorrhage with autonomic seizures (P = 0.003), central nervous system (CNS) infection and stroke with clonic seizures (P = 0.042, P < 0.001, respectively), metabolic/vitamin‐related disorders, and inborn errors of metabolism with myoclonic seizures (P < 0.001). There were also specific electroencephalography (EEG) patterns seen with certain etiologies: vascular disorders and electrolyte imbalance with focal ictal discharges (P < 0.001, P = 0.049 respectively), vitamin‐related disorders with multifocal (P = 0.003), and all categories of genetic disorders with burst‐suppression (P < 0.001). Clonic and autonomic seizures were more frequently present with focal EEG abnormalities (P = 0.001 and P < 0.001), whereas tonic and myoclonic seizures present with burst‐suppression (P = 0.001, P = 0.005). In conclusion, our data suggest that specific associations of etiologies of neonatal seizures with distinct clinical features and EEG patterns might help in the decision to establish appropriate treatment.

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“…Past studies have used ultrasound, computed tomography (CT), and post-mortem pathology to show that intraventricular hemorrhage, hypoxic-ischemic injury and stroke are the most common brain lesions seen in preterm infants with seizures 3-7. However, up to 30% of preterm infants with seizures in these series have no pathology detected by these modalities 6,8,9…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging and Ultrasound Injury in Preterm Infants With Seizures

et al. 2009

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The utility of magnetic resonance imaging (MRI) as a universal screening tool in preterm infants has been contested; however, MR is increasingly used in investigation of neonatal seizures. We evaluated 236 infants <34 weeks gestation at birth. Seizures were documented according to clinical standard of care. Infants were imaged using MRI and head ultrasound during the neonatal period. A neuroradiologist and ultrasonologist performed detailed reviews of the images. Nine infants (3.8%) had clinical suspicion of seizures during the hospital course. MRI was abnormal in each case (three with intraventricular hemorrhage (IVH) and periventricular hemorrhagic infarct, two with findings of hypoxia-ischemia, three with white matter injury (WMI) and one each with schizencephaly and dysplasia –one infant had two lesions). Periventricular hemorrhagic infarct was more common in infants with seizures (33% vs 6% of those without seizures, OR 8.23, 95% CI 1.8-36.7). Infants with seizures were more likely to have WMI, though the difference was not significant (RR 2.4, 95% CI 0.54-11.1, P=0.3). Head ultrasound failed to detect the extent of brain abnormality in eight (89%) of the infants. In this large cohort, infants with clinical suspicion of seizures had a high rate of MRI abnormalities that were not as well characterized by head ultrasound. MRI may be the study of choice for evaluating preterm infants with seizures. Further studies using better seizure monitoring are necessary to evaluate electrographic seizures and their relationship to brain injury on MRI.

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Comparative clinical study of preterm and full-term newborn neonatal seizures

Cited by 24 publications

References 26 publications

Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital

Neurological outcome of newborns with neonatal seizures: a cohort study in a tertiary university hospital

Neonatal seizures: Is there a relationship between ictal electroclinical features and etiology? A critical appraisal based on a systematic literature review

Magnetic Resonance Imaging and Ultrasound Injury in Preterm Infants With Seizures

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