Authors :
Presenting Author: LAURENCE CHATON, MD – lille university hospital
Philippe Derambure, PHD – Lille University Hospital; Laure Lacan, MD – Lille University Hospital; Nadjwa Mahdi, MD – neurologic pediatrician, Lille University Hospital; Sylvie Nguyen, PHD – Lille University Hospital
Rationale:
Neonatal seizures are the most common neurological emergency and are associated with a high risk of mortality and morbidity. There are no specific medical recommendations for follow-up of children who had seizures in the neonatal period. Electroencephalogram (EEG) is the tool of choice in epilepsy. In a 12-year retrospective mono-centric French cohort, we set out to determine characteristics of current management of neonatal seizures and the prevalence, age of onset and distribution by etiology of epilepsies occurring after neonatal seizures. The second objective was to determine whether screening EEGs performed during the first year of life enabled the detection of epileptiform abnormalities prior to diagnosis.
Methods:
We conducted a single-center observational study of children born between January 1, 2008 and December 31, 2020 who were treated for neonatal seizures in the neonatal unit at the University hospital of Lille. All data were collected from the medical records, each EEG done between one and twelve months was reviewed and scored according to the BASED score (Mytinger et al., 2021).
Results: A total of 400 new-borns, including 34.5% preterm, were diagnosed for neonatal seizures before one month. Seizures occurred in 78% of cases within the first 7 days of life. A total of 93 (23%) were under controlled therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). The diagnosis of seizure was EEG confirmed in 260 (67%) newborns. A total of 43% had status epilepticus, half of them lasting more than 24 hours. A total of 12% had no anti-epileptic treatment administered, 45% only one, 43% at least 2 treatments. A total of 159 (38%) benefited from long-term EEG monitoring in the acute phase. In the acute phase, background activity was normal in 95 cases (24.5%), moderately impaired in 143 cases (36.7%) and severely impaired in 150 cases (38.5%). A total of 352 (88%) of EEGs showed paroxysmal activity. In terms of etiology, 69.4% were symptomatic of acute cerebral lesions, 15% were provoked seizures, 13.3% were epilepsy of neonatal onset of genetic, metabolic or developmental structural origin. A total of 106 (26.2%) died before neonatal discharge, 16 (4%) before 24 months of corrected age. Of the 290 survivors, 205 had follow-up neurodevelopmental data, with 139 sequelae, 37 of which were severe. Out of 334 available follow-up datas, 74 (22%) were diagnosed with epilepsy, with the figure representing the type of epilepsy, age of onset, and etiology. A total of 24 (44%) had drug-resistant epilepsy at last follow-up and 23 (42.6%) very abnormal development. A total of 129 children had at least one EEG during the first year of life out of 290 survivors (44%), 44 were subsequently diagnosed with epilepsy and 68 were not. Results from EEG reviewed and scored according to the BASED score are pending.
Conclusions:
This large retrospective cohort shows us the diversity of etiologies of neonatal seizures and how 22% of them evolve toward epilepsy, with a lower proportion of post-natal epilepsy secondary to symptomatic seizures than in the literature, potentially since the generalization of therapeutic hypothermia for HIE and the wider use of EEG monitoring.
Funding:
No special funding.