Predictors for Epilepsy Following Acute Symptomatic Neonatal Seizures Remain Elusive

Potential risk factors for epilepsy in survivors of acute symptomatic neonatal seizure include preterm birth, brain injury, and having antiseizure medications prescribed at discharge following the seizure, according to study findings published in Pediatric Neurology. Despite the findings, adjustment for relevant confounders revealed that these risk factors may be weak predictors of epilepsy in those who survive a neonatal seizure.

Using a database from the Neonatal Neurocritical Care Service at a university hospital in San Francisco, researchers identified neonates with acute symptomatic seizures who were admitted to the neonatal care unit between 2008 and 2014. The researchers sought to identify risk factors for seizures in this population by reviewing hospital records. Specifically, the investigators reviewed demographic data, magnetic resonance imaging (MRI) results, seizure etiology, results on continuous video electroencephalogram, and use of antiseizure medications.

Of the 144 children who met inclusion criteria, 87 patients with ≥1-year follow-up data available for analysis were included. A total of 8 children were diagnosed with epilepsy at a median age of 4.9 (interquartile range 1.7-6.1) years. In the unadjusted analysis, children were more likely to have received an epilepsy diagnosis if they were born preterm, had a brain injury, and were prescribed an antiseizure medication when discharged following the neonatal seizure. In the adjusted analysis, however, there was no significant association between epilepsy and preterm birth (odds ratio 5.6; 95% CI, 0.7-43.1; Wald P =.1) or antiseizure medication at discharge (odds ratio 3.7; 95% CI, 0.6-24.2; Wald P =.2).

A limitation of the study included the review of electroencephalogram and MRI risk factors by clinical reports vs a standardized research review, which limited the researchers’ ability to perform assessments on seizure burden in terms of minutes as well as volume injury on MRI.

Because of a lack of understanding of the reliable risk factors associated with epilepsy in survivors of acute symptomatic neonatal seizures, larger research studies are necessary “to determine precise risk factors for adverse outcomes and epilepsy, and to understand whether neonatal seizure management can alter the risk of epilepsy and childhood disabilities,” the investigators wrote.

Reference

Glass HC, Numis AL, Gano D, Bali V, Rogers EE. Outcomes after acute symptomatic seizures in children admitted to a neonatal neurocritical care service. Pediatr Neurol. 2018;84:39-45.