Abstracts

Rationale: Neonatal seizure is the most common neurologic manifestations in neonates and it could be an important clinical sign of potential brain disorders. The incidence is reported as 1 to 14 per 1,000 live births. It increases the risk of neurodevelopmental impairment, but sometimes it could be difficult to diagnose neonatal seizure due to its variable and subtle clinical features. Early detection of seizure and proper treatment of underlying etiologies as well as seizure itself is very important. The aim of this study is to review the clinical characteristics of neonatal seizures and find the prognostic factors such as etiologies and brain imaging studies. This study could be a valuable data to understand and manage the neonatal seizures. Methods: Twenty-one neonates with clinically identified seizures within one month old who admitted to Dankook University Hospital from July 2007 to June 2009 were included in this study. The medical records including informations about baseline characteristics, etiologies, seizure types, brain imaging such as sonography or MRI, sleep EEGs as well as medications and clinical outcomes were reviewed, reterospectively. Results: Among 21 neonates, 18 (85.7%) were term neonates and 3 (14.3%) were preterm babies. Males (14, 66.7%) were predominant. There were no difference in the delivery patterns (vaginal delivery, 47.6%). The main cause was hypoxic-ischemic encephalopathy (HIE, 7, 33.3%) and there were many other casues including stroke (3, 14.3%), metabolic disturbances such as hypoglycemia or severe hypernatremic dehydration (3, 14.3%), brain anomaly such as partial callosal dysgenesis or left hemimegalencephaly (2, 9.5%), and pyridoxine dependent seizure (1, 4.8%). No more seizure was developed in 4 neonates without medications. Other 17 neonates were treated with anticonvulsants (phenobarbital only in 11, phenobarbital and phenytoin in 2, and multiple drug combinations in 4). One neonate expired due to refractory status epilepticus. Moderate to severe HIE had more grave outcomes. Conclusions: In this study, one third of neonatal seizures were caused by HIE, and moderate to severe HIE had more grave outcomes. In addition, neonatal seizure was a very important clinical sign of a variable underlying etiologies such as stroke, metabolic insults or congenital brain anomaly, therefore, intensive workup and prompt management should be considered for better outcomes.