Neurological Impairment, Developmental Delay and Postneonatal Seizures Two Years after EEG-Video Documented Seizures in Near-Term and Full-Term Neonates: Report of the Clinical Research Centers for Neonatal Seizures.
Abstract number :
D.02
Submission category :
Year :
2001
Submission ID :
621
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
E.M. Mizrahi, MD, Section of Neurophysiology, Dept of Neurology, Baylor College of Medicine, Houston, TX; R.R. Clancy, MD, Pediatric Neurology, Dept of Pediatrics, University of Pennsylvania, Philadelphia, PA; J.K. Dunn, PhD, Dept of Medicine, Baylor Coll
RATIONALE: Long-term consequences of neonatal seizures and their various types are not well-defined.
METHODS: Neonates with EEG-video documented seizures were enrolled at Baylor College of Medicine(CCH) and University of Pennsylvania(CCP) from 1992-96. Consecutive ascertainment was based upon continuous surveillence by all Center staff nurses, each trained in seizure recognition with a standardized video program. All infants suspected of seizures were monitored. Clinical and EEG seizures were confirmed by investigator consensus and classified: electroclinical(EC) with temporal overlap of clinical and electric seizures (clonic, focal tonic, myoclonic); clinical only(CL) with no overlapping electrical activity (generalized tonic, myoclonic, motor automatisms); electrical only(EL) with no clinical events. Assessment at 2 yrs of age included: neurologic examination (Ex), Bayley Mental Developmental and Psychomotor Indices (MDI,PDI) and a history of postneonatal epilepsy.
RESULTS: 207 infants were enrolled (65.7%,CCH; 34.3%,CCP);birthweight, m=3032 gms (763,SD); gestational age, m=37.5 wks(3.5,SD); conceptional age at first recorded seizure, m=38.9 wks(2.9,SD). Seizures were classified as: EC=101(49.5%); EL=68(33.3%); CL=20(9.8%); others=15(7.4%). Initial EEG background was diffusely abnormal in 110 (53.1%): EC,44(43.1%);EL,46(65.7%); CL,9(45.0%); others,11(73.3%). Death occurred in 28% (23.5%,CCH; 36.6%,CCP): EC,20.6%; EL, 31.4%; CL,50%; other,33.3%. At 2 yrs 127(84.7%) of survivors returned with these findings:[table]
CONCLUSIONS: Neonatal seizures in term infants were associated with a high death rate and in returning 2 yr old survivors neurological impairment, developmental delay and postneonatal seizures. Death occurred more often in CL than EC, but not EL. EL survivors were more often abnormal than those with other seizure types. Initial EEG suggested degrees of diffuse brain injury associated with seizure types: EL more often with diffuse brain injury, consistent with a poorer prognosis and suppression of clinical expression of electrical seizure activity; EC with less diffuse injury, consistent with a better outcome and greater expression of the clinical component of EC.
Support: NINDS,NIH Contract NO1-NS-1-2316.