PRENATAL CONTRIBUTIONS TO NEONATAL SEIZURES: IMPLICATIONS FOR EPILEPSY RISK
Abstract number :
A.05
Submission category :
Year :
2003
Submission ID :
4039
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Mark S. Scher Pediatric Neurology, Rainbow Babies and Children[apos]s Hospital, Cleveland, OH; Pediatrics and Neurology, Case Western Reserve University, Cleveland, OH
Neonatal seizures (NS) are surrogate markers which carry a high risk for neurological morbidity including epilepsy, and occur either as part of an evolving newborn encephalopathy (NE) from birth or as a new clinical sign (non-NE) after an asymptomatic immediate postpartum period.
Two-hundred and thirty-six neonates (120 preterm, mean GA 31.5 weeks) had EEG-confirmed seizures with or without clinical accompaniments over a 13-year period (1983-1996).
One hundred and seven infants (45%) had seizures without NE compared with a cohort of 129 who expressed abnormal tone and arousal from birth consistent with NE, only five of whom had intrapartum asphyxia which explained NS with NE based on fetal surveillance and neonatal assessments. Prenatal conditions, particularly during the third trimester, contributed to NS with or without NE which included maternal diseases such as hypertensive disorders of pregnancy, vasculopathies, and genitourinary infections; placental diseases such as fetal vascular thrombosis, chorioamnionitis/funisitis, villus dysmaturity and infarction; and fetal conditions such as multiple gestation, intrauterine growth restriction, hydrops fetalis, and fetal stroke. Neonatal illnesses also contributed to NS with or without NE including CNS infections, acute intracranial hemorrhage, generalized sepsis, and persistent pulmonary hypertension of the newborn.
Only 22 newborns (9%) (15 preterm) had congenital brain malformations and/or inborn errors of metabolism which were ascertained to be the principal etiologies for NS. Seventy-two infants (31%) died (51 preterm), and 37% of survivors had recurrent seizures during childhood (1-13 yrs of age).
A recent multidisciplinary task force between obstetrics and pediatrics has recommended that antepartum factors should be considered more often than intrapartum factors to explain the association between NE and later cerebral palsy1. Maternal, placental and fetal conditions, particularly during the third trimester, should also be considered by epileptologists for patients with a history of NS with or without NE since they are at a higher risk for particularly localization-related epilepsy during childhood.
[Supported by: NS34508]