Outcome following neonatal seizures

Uria-Avellanal, Cristina; Marlow, Neil; Rennie, Janet M.

doi:10.1016/j.siny.2013.01.002

Cited by 95 publications

(80 citation statements)

References 59 publications

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“…An estimated 10%-20% of neonates with seizures from any cause will go on to have further seizures in childhood. 6 Our objective was to measure the incidence rate and risk factors for a first remote seizure after perinatal AIS utilizing a previously identified population-based pediatric stroke cohort that included neonates presenting acutely with stroke and patients with PPIS. We hypothesized that seizures during the neonatal period were associated with a higher risk of remote seizure and From the Departments of Neurology…”

Section: Methodsmentioning

confidence: 99%

Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke

et al. 2016

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Objectives: To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke. Methods:We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian integrated health care system. We determined incidence and predictors of a remote seizure (unprovoked seizure after neonatal period, defined as 28 days of life) by survival analyses, and measured epilepsy severity in those with active epilepsy ($1 remote seizure and maintenance anticonvulsant treatment) at last follow-up.Results: Among 87 children with perinatal stroke, 40 (46%) had a seizure in the neonatal period.During a median follow-up of 7.1 years (interquartile range 3.2-10.5), 37 children had $1 remote seizure. Remote seizure risk was highest during the first year of life, with a 20% (95% confidence interval [CI] 13%-30%) cumulative incidence by 1 year of age, 46% (CI 35%-58%) by 5 years, and 54% (CI 41%-67%) by 10 years. Neonatal seizures increased the risk of a remote seizure (hazard ratio 2.8, CI 1.3-5.8). Children with neonatal seizures had a 69% (CI 48%-87%) cumulative incidence of remote seizure by age 10 years. Among the 24 children with active epilepsy at last follow-up, 8 (33%) were having monthly seizures despite an anticonvulsant and 7 (29%) were on more than one anticonvulsant.Conclusions: Remote seizures and epilepsy, including medically refractory epilepsy, are common after perinatal stroke. Neonatal seizures are associated with nearly 3-fold increased remote seizure risk. Neurology ® 2016;86:2179-2186 GLOSSARY AIS 5 arterial ischemic stroke; CI 5 confidence interval; HR 5 hazard ratio; ICD-9 5 International Classification of Diseases-9; IQR 5 interquartile range; KPNC 5 Kaiser Permanente Northern California; PPIS 5 presumed perinatal ischemic stroke.Perinatal arterial ischemic stroke (AIS) occurs in 1 in 4,000 term births and is an important cause of childhood epilepsy.1 In some newborns, an ischemic brain injury is initially unrecognized and only diagnosed later during development when a hemiparesis becomes clinically apparent or a remote symptomatic seizure occurs. This subset often receives a diagnosis of presumed perinatal ischemic stroke (PPIS), which refers to a stroke presumed to have occurred in the perinatal period because of a chronic focal infarction on neuroimaging.2 Stroke that is clinically apparent in the neonatal period may differ from PPIS. Seizures during the neonatal period are perhaps the most notable factor differentiating these groups, and are reported in about 75%-90% of infants diagnosed with stroke during the perinatal period.3-5 Neonatal seizures of any cause may confer a long-term risk of postnatal epilepsy. An estimated 10%-20% of neonates with seizures from any cause will go on to have further seizures in childhood. 6 Our objective was to measure the incidence rate and risk factors for a first remote seizure after perinatal AIS utilizing a previo...

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Section: Methodsmentioning

confidence: 99%

Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke

et al. 2016

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“…1 More than 50% of survivors experience considerable disability across a range of developmental domains, most frequently cerebral palsy, post-neonatal epilepsy, and/or intellectual disability, 1,2 requiring costly, lifelong therapies and social and academic support.…”

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confidence: 99%

Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study

Glass

Shellhaas

Wusthoff

et al. 2016

The Journal of Pediatrics

240

213

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Objective To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG). Study design We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks postmenstrual age with clinically suspected seizures and/or electrographic seizures. Subjects were assessed between January 2013 and April 2015 at seven U.S. tertiary care pediatric centers following American Clinical Neurophysiology Society (ACNS) guidelines for cEEG for at risk neonates. Seizure etiology, burden, management and outcome were determined by chart review using a case report form designed at study onset. Results The most common seizure etiologies were hypoxic-ischemic encephalopathy (38%), ischemic stroke (18%), and intracranial hemorrhage (11%). Seizure burden was high, with 59% having ≥7 electrographic seizures and 16% having status epilepticus; 52% received ≥2 anti-seizure medications. During the neonatal admission, 17% died; 49% of survivors had abnormal neurological examination at hospital discharge. In an adjusted analysis, high seizure burden was a significant risk factor for mortality, length of hospital stay, and abnormal neurological examination at discharge. Conclusions In this large contemporary profile of consecutively enrolled newborns with seizures treated at centers using cEEG per ACNS guidelines, about half had high seizure burden, received ≥2 anti-seizure medications, and/or died or had abnormal examination at discharge. Higher seizure burden was associated with increased morbidity and mortality. These findings underscore the importance of accurate determination of neonatal seizure frequency and etiology, and a potential for improved outcome if seizure burden is reduced.

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“…Generalised myoclonic seizures are well localised, migrating jerky movements and usually involve the arms. Myoclonic seizures must be differentiated from clonic seizures 4 5…”

Section: Discussionmentioning

confidence: 99%