Neonatal Seizures;

Abstract

Objective: To study the types, etiology and long term neurodevelopmentaloutcome in neonates with seizures. Study Design: A descriptive cross-sectional study. Placeand Duration of Study: PNS Shifa Naval hospital Karachi from Jan 2011 to Feb 2014. StudyPopulation: Ninety six neonates of either gender presented with seizures at NICU PNS ShifaNaval hospital Karachi were studied. Method: All neonates with seizures were evaluated.The seizures were classified according to the simiology. They were investigated according toNICU protocol to confirm the underlying diagnosis and timely management. The patients afterdischarge were regularly followed up for one year to assess the long term neurodevelopmentaloutcome. Results: A total of 96 neonates with seizures were studied and it was observedthat 60 (62.5%) were male babies and 56 (58.33%) were term with a male to female ratio of1.6:1. Majority of the neonatal seizures were seen in 1stweek of life (85%). The most commontype of seizures was clonic 40 (41.67%) followed by subtle 20 (20.84%), mixed 16 (16.67%),tonic 10 (10.41%), myoclonic 5 (5.20%) and unclassified 5 (5.20%). Antiepileptics were usedin 82 (85.41%) patients. Phenobarbitone 49 (59.76%) was most commonly prescribed drug.The most common cause of seizures was birth asphyxia 48 (50%) followed by metabolic 16(16.68%), sepsis 10 (10.41%), intracranial hemorrhage 6 (6.25%), bilirubin encephalopathy 4(4.16%), inborn errors of metabolism 2 (2.08%), birth trauma 2 (2.08%) and unknown etiology 5(5.20%). 25 (26.04%) patients develop adverse neurodevelopmental outcome i.e. cerebral palsywith epilepsy 10 (40%) and cerebral palsy without epilepsy 05 (20%), developmental delay 10(40%). Mortality in the study was 12 (12.5%). Conclusions: Clonic seizures are commonestin neonates apart from infants and children who have GTCS. The most common etiology ofseizures in neonates is birth asphyxia. Phenobarbitone is still the most commonly prescribedantiepileptic. Quick assessment, timely diagnosis and aggressive management according tothe etiology are necessary to prevent the morbidity and mortality associated with neonatalseizures. Long term neurodevelopmental outcome is worse in patients with birth asphyxiaespecially with low Apgar score at 5 minutes. Normal delivery and birth asphyxia were the majorrisk factors for cerebral palsy