Abstracts

Rationale: Intracranial hemorrhage (ICH), including subdural, subarachnoid, cerebellar, intraventricular and intraparenchymal subtypes, accounts for about 50% of all neonatal stroke. Previous studies examining outcome after perinatal hemorrhagic stroke have evaluated the contribution of size/volume and location of hemorrhage as well as pre-existing risk factors. Overall, outcome is favorable and studies find between 60 and 83 percent of surviving children have no physical and cognitive deficits at follow-up. Hypotheses: 1) There is a lack of association between seizure pattern (clinical features, electrographic seizures, electrographic status, number of anticonvulsants needed to control seizures) at presentation and location of hemorrhage. 2) The severity at presentation does not correlate with risk of developing epilepsy.Methods: A retrospective study was performed at a tertiary free-standing children s hospital following approval from the institutional review board. Subjects were identified by electronic database search of EEG reports from 2007 2013. Neonates with ICH and confirmed seizures were included. An exclusion criterion was < 36 weeks estimated gestation age at birth. The selected subjects charts were reviewed for variables including: 1) Characteristics and evolution of ICH; 2) Characteristics of seizures (at presentation); 3) Seizures at follow-up visits.Results: Sixteen patients with ICH, neonatal seizures, and EEG were identified. Initial seizure presentation varied among neonatal patients with respect to severity of ictal and interictal EEG abnormalities. Three patients required more than one anticonvulsant to control seizures. There was no obvious correlation between location of hemorrhage and severity of seizures and EEG abnormalities at time of presentation. Four patients did not have follow up information beyond the neonatal period (1 death, 1 lost to follow up after initial clinic visit, and 2 with hospital follow up at local facility). Twelve of 16 patients had follow up at 6 months old. Eleven of these patients (92%) were seizure free, and 8 out of those 11 were off all anticonvulsants. One patient required a ventriculoperitoneal shunt in the neonatal period and subsequently developed infantile spasms and hemi-hypsarhythmia.Conclusions: We retrospectively identified subjects with neonatal seizures secondary to ICH and correlated initial clinical presentation and acute management, imaging, and EEG characteristics associated with outcome. The main finding is that the subsequent development of epilepsy in this population is independent of the severity of acute seizures. This preliminary study provides important information regarding the indications and value of neurophysiological studies in this at risk neonatal patient population. Future research will endeavor to increase the sample size and validate the findings.