Epilepsy and seizures in children with congenital heart disease: A prospective study

Desnous, Béatrice; Lenoir, Marien; Doussau, Amélie; Marandyuk, Bohdana; Beaulieu-Genest, Laurence; Poirier, Nancy; Carmant, Lionel; Birca, Ala

doi:10.1016/j.seizure.2018.11.011

Cited by 26 publications

(19 citation statements)

References 12 publications

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“…Electrographic seizures occurred in 8.4% of neonates following cardiac surgery with CPB, consistent with published literature 1,5,28 . PHB and LEV were the most commonly administered first‐line ASMs.…”

Section: Discussionsupporting

confidence: 86%

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A retrospective comparison of phenobarbital and levetiracetam for the treatment of seizures following cardiac surgery in neonates

et al. 2020

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Objective: To compare the safety and efficacy of phenobarbital and levetiracetam in a cohort of neonates with seizures following cardiac surgery. Methods: We performed a retrospective single-center study of consecutive neonates with electrographically confirmed seizures managed with antiseizure medication after cardiac surgery from June 15, 2012 to December 31, 2018. We compared the safety and efficacy of phenobarbital and levetiracetam as first-line therapy. Results: First-line therapy was phenobarbital in 31 neonates and levetiracetam in 22 neonates. Phenobarbital was associated with more adverse events (P = .006).Eight neonates (14%) experienced an adverse event related to phenobarbital use, including seven with hypotension and one with respiratory depression. No adverse events were reported with levetiracetam use. The cessation of electrographic seizures was similar in both groups, including 18 neonates (58%) with seizure cessation after phenobarbital and 12 neonates (55%) with seizure cessation after levetiracetam (P = 1.0). The combined cessation rates of phenobarbital and levetiracetam when used as first-or second-line therapy were 58% and 47%, respectively (P = .47). Significance: Phenobarbital was associated with more adverse events than levetiracetam, and the two drugs were equally but incompletely effective in treating electrographically confirmed seizures in neonates following cardiac surgery.Given its more acceptable safety profile and potential noninferiority, levetiracetam may be a reasonable option for first-line therapy for treatment of seizures in this population. Further prospective studies are needed to confirm these results. K E Y W O R D Scardiology, congenital, critical care, heart diseases, infant 628 | THIBAULT eT AL.

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Section: Discussionsupporting

confidence: 86%

“…Neonates with congenital heart disease (CHD) undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk for seizures, with a reported incidence ranging between 5% and 20% 1–7 . The occurrence of postoperative seizures is associated with in‐hospital mortality and worse neurodevelopmental outcomes 1,8–10 .…”

Section: Introductionmentioning

confidence: 99%

A retrospective comparison of phenobarbital and levetiracetam for the treatment of seizures following cardiac surgery in neonates

et al. 2020

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“…Children with congenital heart disease who are at risk for epilepsy in our population are similar to the Danish and Canadian study. 6,7 However, our patients with epilepsy did not seize during their intensive care unit hospitalization. Seizures in our cohort were more likely provoked from their encephalopathy regardless of etiology.…”

Section: Discussionmentioning

confidence: 84%

“…Extracorporeal membrane oxygenation use and hospital stay were also associated with epilepsy. 7 The purpose of our study is to describe and analyze the semiology, incidence, and potential risk factors for seizures and epilepsy in neonates and infants under 3 months of age with congenital heart disease and perioperative seizures at a tertiary referral center. Using this information, we seek to create a model to identify patients at higher risk for seizures during the pre-and postoperative phase of their initial hospitalization.…”

mentioning

confidence: 99%

Risk Factors for Seizures and Epilepsy in Children With Congenital Heart Disease

et al. 2020

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Objectives: To identify potential risk factors for pre- and postoperative seizures and epilepsy in children with congenital heart disease. Methods: Retrospective cohort study of neonates and infants <3 months of age with congenital heart disease who underwent cardiopulmonary bypass from November 24, 2006, until June 1, 2015. Children with seizures were classified based on time of occurrence into early preoperative, early postoperative, and late postoperative. Children with recurring seizures 30 days after cardiac surgery met criteria for epilepsy. Results: 247 patients completed follow-up; 2.4% had seizures early preoperation and 1.6% early postoperation. Late postoperative epilepsy occurred in 5.3% of the cohort. The majority of seizures in the late postoperative epilepsy group started after 1 year of age (mean 1.53 years, range = 0.18-4.7 years). One of the 13 patients with epilepsy had a seizure during their intensive care unit hospitalization. Potential risk factors for seizures included brain injury ( P < .001), high-risk surgery (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score ≥3, P = .024), and low birth weight ( P < .04). Infants with stroke were more likely to develop epilepsy ( P = .04). Presence of seizures was associated with increased length of stay ( P < .001). Conclusions: Our study suggests an association between children with congenital heart disease diagnosed with stroke in the neonatal/infancy period and the development of epilepsy. These children may not have prior early pre- and postoperative seizures. Risk factors for seizures include brain injury, high-risk surgery, and lower birth weight. Seizures were associated with an increased length of stay but did not necessarily lead to subsequent epilepsy.

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“…Additionally, they may experience feeding 45 and nutritional challenges, 46 which have been documented as risk factors for subsequent developmental concerns. 47 The high risk of neurological issues reported in this population 39 is likely due to their metabolic, nutritional, respiratory, and cardiac instability, which increases the risk of stroke and seizures, 48 and subsequent cognitive impairments. 49,50 Interestingly, in our study, length of ICU stay and listing status at the time of HTx did not have significant correlations with various cognitive domains.…”

Section: Discussionmentioning

confidence: 99%

Early school‐age cognitive performance post–pediatric heart transplantation

Gold

Bondi

Ashkanase

et al. 2020

Pediatric Transplantation

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Background: As survival in pediatric heart transplantation (HTx) has improved due to medical advances, the analysis of long-term outcomes impacting quality of life such as cognition and development becomes increasingly important. Neuropsychological assessments provide a comprehensive understanding of individual needs, allowing for the development of tailored recommendations and interventions. Methods: Routine neuropsychological assessment was completed between 5 and 7 years of age in this cohort of pediatric HTx recipients at our center (Jan 2014-Oct 2018), including tests of general intellect (WPPSI-IV, WISC-V), academics (WIAT-II/ III), perceptual-motor abilities (Beery VMI-6), and memory (CMS). Relevant medical variables were collected. Results: Among 25 children, the median age at testing was 6.7 (IQR:5.8-7.4) years, with a median time since HTx of 5.2 (IQR:4.8-6.8) years. Medical diagnoses included congenital heart disease (CHD; 56%) and cardiomyopathy (44%). Cognitive functioning across the intellectual, academic, and perceptual-motor domains fell within the low-average range, while memory abilities fell within the average range. DSM-5 clinical diagnoses were provided for 14 (56%) children: Intellectual Disability-Mild (20%), Learning Disability (20%), Language Disorder (8%), and Attention-Deficit/ Hyperactivity Disorder (12%). The presence of neurological issues and/or CHD predicted poorer performance on various neuropsychological domains. Conclusions: Over 50% of this cohort of pediatric heart transplant recipients seen for routine post-HTx neuropsychological assessment received a clinical psychological diagnosis, notably higher than rates in the general population. This population requires monitoring to ensure that high risk children are identified and successfully supported in school and their community.

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Epilepsy and seizures in children with congenital heart disease: A prospective study

Cited by 26 publications

References 12 publications

A retrospective comparison of phenobarbital and levetiracetam for the treatment of seizures following cardiac surgery in neonates

A retrospective comparison of phenobarbital and levetiracetam for the treatment of seizures following cardiac surgery in neonates

Risk Factors for Seizures and Epilepsy in Children With Congenital Heart Disease

Early school‐age cognitive performance post–pediatric heart transplantation

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