TY - JOUR
T1 - Early-life epilepsy after acute symptomatic neonatal seizures
T2 - A prospective multicenter study
AU - Shellhaas, Renée A.
AU - Wusthoff, Courtney J.
AU - Numis, Adam L.
AU - Chu, Catherine J.
AU - Massey, Shavonne L.
AU - Abend, Nicholas S.
AU - Soul, Janet S.
AU - Chang, Taeun
AU - Lemmon, Monica E.
AU - Thomas, Cameron
AU - McNamara, Nancy A.
AU - Guillet, Ronnie
AU - Franck, Linda S.
AU - Sturza, Julie
AU - McCulloch, Charles E.
AU - Glass, Hannah C.
N1 - Funding Information:
The study investigators would like to thank the Neonatal Seizure Registry Parent Advisory Panel members for their invaluable guidance, as well as the clinical research coordinators at each site for their tireless work enrolling and following study participants. This study was supported by the Patient Centered Outcomes Research Institute (1507-31187) and the Pediatric Epilepsy Research Foundation.
Funding Information:
The study investigators would like to thank the Parent Advisory Panel members for their invaluable guidance, as well as the clinical research coordinators at each site for their tireless work enrolling and following study participants. This study was supported by the Patient Centered Outcomes Research Institute (1507‐31187) and the Pediatric Epilepsy Research Foundation. Neonatal Seizure Registry
Publisher Copyright:
© 2021 International League Against Epilepsy
PY - 2021/8
Y1 - 2021/8
N2 - Objective: We aimed to evaluate early-life epilepsy incidence, seizure types, severity, risk factors, and treatments among survivors of acute neonatal seizures. Methods: Neonates with acute symptomatic seizures born 7/2015-3/2018 were prospectively enrolled at nine Neonatal Seizure Registry sites. One-hour EEG was recorded at age three months. Post-neonatal epilepsy and functional development (Warner Initial Developmental Evaluation of Adaptive and Functional Skills – WIDEA-FS) were assessed. Cox regression was used to assess epilepsy-free survival. Results: Among 282 infants, 37 (13%) had post-neonatal epilepsy by 24-months [median age of onset 7-months (IQR 3–14)]. Among those with post-neonatal epilepsy, 13/37 (35%) had infantile spasms and 12/37 (32%) had drug-resistant epilepsy. Most children with post-neonatal epilepsy had abnormal neurodevelopment at 24-months (WIDEA-FS >2SD below normal population mean for 81% of children with epilepsy vs 27% without epilepsy, RR 7.9, 95% CI 3.6–17.3). Infants with severely abnormal neonatal EEG background patterns were more likely to develop epilepsy than those with mild/moderate abnormalities (HR 3.7, 95% CI 1.9–5.9). Neonatal EEG with ≥3 days of seizures also predicted hazard of epilepsy (HR 2.9, 95% CI 1.4–5.9). In an adjusted model, days of neonatal EEG-confirmed seizures (HR 1.4 per day, 95% CI 1.2–1.6) and abnormal discharge examination (HR 3.9, 95% CI 1.9–7.8) were independently associated with time to epilepsy onset. Abnormal (vs. normal) three-month EEG was not associated with epilepsy. Significance: In this multicenter study, only 13% of infants with acute symptomatic neonatal seizures developed post-neonatal epilepsy by age 24-months. However, there was a high risk of severe neurodevelopmental impairment and drug-resistant seizures among children with post-neonatal epilepsy. Days of EEG-confirmed neonatal seizures was a potentially modifiable epilepsy risk factor. An EEG at three months was not clinically useful for predicting epilepsy. These practice changing findings have implications for family counseling, clinical follow-up planning, and future research to prevent post-neonatal epilepsy.
AB - Objective: We aimed to evaluate early-life epilepsy incidence, seizure types, severity, risk factors, and treatments among survivors of acute neonatal seizures. Methods: Neonates with acute symptomatic seizures born 7/2015-3/2018 were prospectively enrolled at nine Neonatal Seizure Registry sites. One-hour EEG was recorded at age three months. Post-neonatal epilepsy and functional development (Warner Initial Developmental Evaluation of Adaptive and Functional Skills – WIDEA-FS) were assessed. Cox regression was used to assess epilepsy-free survival. Results: Among 282 infants, 37 (13%) had post-neonatal epilepsy by 24-months [median age of onset 7-months (IQR 3–14)]. Among those with post-neonatal epilepsy, 13/37 (35%) had infantile spasms and 12/37 (32%) had drug-resistant epilepsy. Most children with post-neonatal epilepsy had abnormal neurodevelopment at 24-months (WIDEA-FS >2SD below normal population mean for 81% of children with epilepsy vs 27% without epilepsy, RR 7.9, 95% CI 3.6–17.3). Infants with severely abnormal neonatal EEG background patterns were more likely to develop epilepsy than those with mild/moderate abnormalities (HR 3.7, 95% CI 1.9–5.9). Neonatal EEG with ≥3 days of seizures also predicted hazard of epilepsy (HR 2.9, 95% CI 1.4–5.9). In an adjusted model, days of neonatal EEG-confirmed seizures (HR 1.4 per day, 95% CI 1.2–1.6) and abnormal discharge examination (HR 3.9, 95% CI 1.9–7.8) were independently associated with time to epilepsy onset. Abnormal (vs. normal) three-month EEG was not associated with epilepsy. Significance: In this multicenter study, only 13% of infants with acute symptomatic neonatal seizures developed post-neonatal epilepsy by age 24-months. However, there was a high risk of severe neurodevelopmental impairment and drug-resistant seizures among children with post-neonatal epilepsy. Days of EEG-confirmed neonatal seizures was a potentially modifiable epilepsy risk factor. An EEG at three months was not clinically useful for predicting epilepsy. These practice changing findings have implications for family counseling, clinical follow-up planning, and future research to prevent post-neonatal epilepsy.
KW - anti-seizure medication
KW - electroencephalogram
KW - epilepsy
KW - hypoxic-ischemic encephalopathy
KW - infantile spasms
KW - neonatal encephalopathy
KW - neonatal seizures
KW - neurocritical care
KW - seizure
UR - http://www.scopus.com/inward/record.url?scp=85109323066&partnerID=8YFLogxK
U2 - 10.1111/epi.16978
DO - 10.1111/epi.16978
M3 - Article
C2 - 34212365
AN - SCOPUS:85109323066
SN - 0013-9580
VL - 62
SP - 1871
EP - 1882
JO - Epilepsia
JF - Epilepsia
IS - 8
ER -