Neonatal Encephalopathy, MRI Lesions, and Later Epilepsy: No Harm, No Foul?

Abstract

In Clinical Science Commentary Neonatal encephalopathy refers to the clinical manifestations of acute perinatal brain injury, most commonly as a result of a hypoxic-ischemic insult. Neonatal seizures are a potentially treatable manifestation of moderate to severe neonatal encephalopathy and have long been recognized as a risk factor for later developmental deficits (1). The million-dollar question is: are seizures merely a marker for injury severity (2) or do neonatal seizures contribute to the injury (3)? If the latter is true, then seizures should be treated aggressively. However, neonatal seizures can only reliably be identified by electrographic monitoring (4) and are frequently refractory to anticonvulsant treatment (5). Further, there are theoretical reasons to be concerned that some treatment strategies for neonatal seizures could be toxic (6). Experimental anticonvulsant neurotoxicity has only been demonstrated with high dosages, has only been demonstrated acutely, and has only been demonstrated in normal animals rather than injured animals, let alone in animals with repetitive seizures. Nevertheless, the possibility of toxicity makes it all the more important to know whether successful treatment of neonatal seizures actually benefits the patient.