Early Discontinuation of Anti-seizure Medication in Neonates with Hypoxic-ischemic Encephalopathy Does Not Increase the Incidence of Seizures at 6 and 12 Months
Abstract number :
3.22
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2204504
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Spoorthi Jagadish, MD – University of Iowa; Theresa Czech, MD – University of Iowa; Bridget Zimmerman, PhD – University of Iowa; Joseph Glykys, MD, PhD – University of Iowa
Rationale: Neonates with Hypoxic-Ischemic Encephalopathy (HIE) are at high risk for seizures. Phenobarbital and levetiracetam are common anti-seizure medications used in this population during the acute period. However, there is no established consensus on the duration of anti-seizure medication (ASM) administration after the resolution of acute symptomatic neonatal seizures. We aimed to determine if there was a difference in seizure recurrence at 6 and 12 months based on the duration of ASM treatment after acute resolution of neonatal seizures due to HIE.
Methods: We performed a retrospective chart review study of all neonates admitted to The University of Iowa Stead Family Department of Pediatrics Neonatal Intensive care unit (NICU) with a diagnosis of neonatal encephalopathy and presumed HIE who underwent therapeutic hypothermia between 1/1/2007 to 2/15/2021. Only neonates who developed acute seizures were included in the study. We evaluated multiple clinical variables to ascertain if the duration of ASM treatment altered the seizure recurrence risk at 6 and 12 months of life. Our Institutional Research Board approved the research.
Results: There were 215 neonates with neonatal encephalopathy and presumed HIE who underwent therapeutic hypothermia, out of which 69 developed seizures and were included in the study. The median gestational age was 39.1 [IQR: 38-40.4] weeks, and 38 neonates (55%) were male. Forty-one of the 69 neonates (59.4%) were discharged home on ASM and treated with a median duration of 4 [2.5-5.5] months. Seizure recurrence was seen in 6 neonates (8.7%) at 6-month and 9 (13%) at 12-month follow-up. There was no statistical difference in seizure recurrence between the neonates discharged home on ASM and those not discharged on ASM.
Conclusions: Early discontinuation of ASM after resolution of acute symptomatic seizures in neonates who underwent therapeutic hypothermia for HIE was not associated with increased seizure recurrence at 6 and 12 months of life compared to patients discharged home on ASM.
Funding: Joseph Glykys is supported by the Iowa Neuroscience Institute.
Clinical Epilepsy