Symptomatic seizures in preterm newborns: a review on clinical features and prognosis

Abstract

Neonatal seizures are the most common neurological event in newborns, showing higher prevalence in preterm than in full-term infants. In the majority of cases they represent acute symptomatic phenomena, the main etiologies being intraventricular haemorrhage, hypoxic-ischemic encephalopathy, central nervous system infections and transient metabolic derangements.Current definition of neonatal seizures requires detection of paroxysmal EEG-changes, and in preterm newborns the incidence of electrographic-only seizures seems to be particularly high, further stressing the crucial role of electroencephalogram monitoring in this population. Imaging work-up includes an integration of serial cranial ultrasound and brain magnetic resonance at term-equivalent age. Unfavourable outcomes following seizures in preterm infants include death, neurodevelopmental impairment, epilepsy, cerebral palsy, hearing and visual impairment. As experimental evidence suggests a detrimental role of seizures per se in determining subsequent outcome, they should be promptly treated with the aim to reduce seizure burden and long-term disabilities. However, neonatal seizures show low response to conventional anticonvulsant drugs, and this is even more evident in preterm newborns, due to intrinsic developmental factors. As a consequence, as literature does not provide any specific guidelines, due to the lack of robust evidence, off-label medications are often administered in clinical practice.

Impaired Tuning of Afferent Excitatory Synapses onto Hippocampal Fast-Spiking Interneurons by Acute Early Life Seizures

“…Other common causes of ELS include infections of the central nervous system, maternal drug abuse and rare epilepsy syndromes (Volpe, 2001). Also, the prevalence rate of seizures in preterm infants is much higher than full-term infants and these seizures tend to be less responsive to conventional AEDs (Spagnoli et al, 2018).…”

“…Recent studies have shown that the duration and the number of seizures is highly correlated with adverse prognosis, suggesting that fast and accurate diagnosis is crucial for effective ELS treatments (Kasahara et al, 2018). The most common clinical diagnostic tool for ELS is the use of non-invasive electroencephalogram (EEG) technology to detect distinct electrographic features of ELS (Spagnoli et al, 2018;Fisher et al, 2018). EEG has been used for decades as a tool to detect and diagnose seizures and still remains as one of our best tools for detecting abnormal neuronal activity and predicting outcomes (Rowe 1985;Spagnoli et al, 2018).…”

“…The most common clinical diagnostic tool for ELS is the use of non-invasive electroencephalogram (EEG) technology to detect distinct electrographic features of ELS (Spagnoli et al, 2018;Fisher et al, 2018). EEG has been used for decades as a tool to detect and diagnose seizures and still remains as one of our best tools for detecting abnormal neuronal activity and predicting outcomes (Rowe 1985;Spagnoli et al, 2018). Even after the diagnosis and treatment of seizures, it is often recommended to continue EEG monitoring in order to quantify "seizure burden" and gain better prognosis information in infants (Insel et al, 1990;Lawrence and Inder, 2010;Spagnoli et al, 2018).…”

“…EEG has been used for decades as a tool to detect and diagnose seizures and still remains as one of our best tools for detecting abnormal neuronal activity and predicting outcomes (Rowe 1985;Spagnoli et al, 2018). Even after the diagnosis and treatment of seizures, it is often recommended to continue EEG monitoring in order to quantify "seizure burden" and gain better prognosis information in infants (Insel et al, 1990;Lawrence and Inder, 2010;Spagnoli et al, 2018). The use of EEG is relatively safe; however, the cost of EEG equipment and maintenance, as well as the variability in EEG result interpretation by the clinical staff, present some limitations (Lawrence and Inder, 2010).…”

“…The use of EEG is relatively safe; however, the cost of EEG equipment and maintenance, as well as the variability in EEG result interpretation by the clinical staff, present some limitations (Lawrence and Inder, 2010). Other forms of neuroimaging approaches used to diagnose and monitor seizures in infants include cranial ultrasound scans and MRI scans (Spagnoli et al, 2018).…”