Abstracts

Rationale: Neonates with hypoxic-ischemic encephalopathy (HIE) managed with therapeutic hypothermia (TH) often experience acute symptomatic seizures, prompting treatment with anti-seizure medications (ASM). Because the risk of seizure recurrence after hospital discharge is unknown, the optimal duration of therapy with ASM is unclear. We aimed to determine the risk of seizure occurrence after hospital discharge and the impact of ASM treatment duration on this outcome. Methods: We performed a single-center, retrospective study of consecutive neonates with HIE managed with TH, who received ASM for acute symptomatic clinical or electrographic seizures from June 2010 through December 2014. Clinical characteristics, EEG features, and seizure occurrence in follow-up were abstracted from electronic medical records. Results: Follow-up data were available for 59/72 (82%) neonates who survived to discharge, with a median follow-up period of 19 months. Acute symptomatic seizures occurred in 35 (59%), with EEG-confirmed seizures in 21 (36%). ASM were continued upon discharge in 15 neonates with EEG-confirmed seizures and in 2 with only clinically apparent seizures. Seizures occurred in follow-up in 4 neonates (7%), all of whom experienced acute symptomatic seizures. No patient for whom ASM were discontinued prior to discharge experienced seizures during the follow-up period. Conclusions: Seizures after hospital discharge were rare for neonates with HIE who had acute symptomatic seizures, and they did not occur in neonates without acute symptomatic seizures. ASM discontinuation prior to discharge did not increase the risk of seizure occurrence during follow-up, suggesting that neonates may discontinue ASM without substantial risk for future seizures. Funding: Funding from NINDS K23NS076550