Abstracts

RATIONALE: Neonatal seizures are classified as undetermined epilepsies with both generalized and focal seizures.
The aim of our study is to evaluate how many and which of our newborns with neonatal seizures developed subsequent epilepsy and type of epileptic form they presented.
METHODS: We reviewed the data of 2207 newborns consecutively admitted to the Neonatal Intensive Care Unit of University of Parma during the last seven years. Fifty-six patients were selected according to the following criteria: repetitive neonatal seizures treated with antiepileptic drugs, more than one EEG performed during the neonatal period, at least one imaging examination (Cerebral Ultrasounds and/or Cerebral MRI) and neurological follow-up longer than six months. The neonatal seizure type and the epilepsies were identified according to the Classification of the International League Against Epilepsy ([ssquote]81 - [ssquote]89).
RESULTS: The average of the seizures onset was for the preterms 6,2 days, and for the newborns at term at 5,8 days, while their gestational age ranged from 25 to 42 weeks. Aetiological factors were: hypoxic-ischaemic insult in 17/56, intracranial hemorrhage in 19/56, cerebral malformation in 6/56, metabolic disorders in 7/56, sepsis in 3/56 and 4/56 with fetal chronic distress.
The outcome of the 47 patients (nine lost during the follow-up) has been: normal in 22/47; neurological impairment without epilepsy in 6/47; epileptic encephalopathy in 14/47, death in 5/47. All the 56 patients had partial seizures while 3 of them presented both partial and generalized seizure.
The most frequent seizures type was clonic unifocal and multifocal, however tonic seizures were present in 9/14 newborns who had epileptic encephalopathy and in the 5 who died. The 3 newborns with both types of seizures presented as causative factors: inborn error of metabolism (2) and holoprosencephaly. Today, among the epileptic patients: 9/14 developed symptomatic localization-related epilepsy with motor partial seizure and with secondary generalization in 6/14; three of them developed a transient West syndrome; 4/14 present a generalized symptomatic epilepsy such as West syndrome (3) and Aicard[igrave] syndrome (1); one died at three months of life. All of them (14/14) had an abnormal background EEG activity since birth together with more specific epileptic abnormalities.
CONCLUSIONS: In summary the tonic seizures represent a negative prognostic factors. Furthermore, most of the patients with cerebral lesions and neonatal seizures may develop symptomatic localization-related epilepsy, sometimes throughout a transient West syndrome.