Outcomes after acute symptomatic seizures in neonates.

Published on Jan 1, 2018in Seminars in Fetal & Neonatal Medicine3.926
· DOI :10.1016/J.SINY.2018.02.001
Hannah C. Glass39
Estimated H-index: 39
(UCSF: University of California, San Francisco),
Zachary M. Grinspan18
Estimated H-index: 18
(Cornell University),
Renée A. Shellhaas31
Estimated H-index: 31
(UM: University of Michigan)
Sources
Abstract
Abstract Acute symptomatic seizures are a common sign of neurological dysfunction and brain injury in neonates and occur in approximately one to three per 1000 live births. Seizures in neonates are usually a sign of underlying brain injury and, as such, are commonly associated with adverse outcomes. Neurological morbidities in survivors often co-occur; epilepsy, cerebral palsy, and intellectual disability often occur together in the most severely affected children. Risk factors for adverse outcome include prematurity, low Apgar scores, low pH on the first day of life, seizure onset 72 h after birth, abnormal neonatal neurological examination, abnormal neonatal electroencephalographic background, status epilepticus, and presence and pattern of brain injury (particularly deep gray or brainstem injury). Despite this list of potential indicators, accurate prediction of outcome in a given child remains challenging. There is great need for long-term, multicenter studies to examine risk factors for, and pathogenesis of, adverse outcomes following acute symptomatic seizures in neonates.
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References49
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#1Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 39
#2Renée A. Shellhaas (UM: University of Michigan)H-Index: 31
Last. Janet S. Soul (Boston Children's Hospital)H-Index: 39
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Abstract Background The purpose of this study was to characterize seizures among preterm neonates enrolled in the Neonatal Seizure Registry, a prospective cohort of consecutive neonates with seizures at seven pediatric centers that follow the American Clinical Neurophysiology Society's neonatal electroencephalography monitoring guideline. Study Design Of 611 enrolled neonates with seizures, 92 (15%) were born preterm. Seizure characteristics were evaluated by gestational age at birth for extreme...
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#1Tiffani L. McDonough (CUMC: Columbia University Medical Center)H-Index: 8
#2Juliann M. Paolicchi (Hackensack University Medical Center)H-Index: 12
Last. Zachary M. Grinspan (Cornell University)H-Index: 18
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Epilepsy outcomes after therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy are understudied. The authors used multivariable logistic regression to predict epilepsy in neonates after selective head cooling. Sensitivity analyses used magnetic resonance imaging (MRI) and electroencephalogram (EEG) interpretations by different clinicians. Fifty neonates had 2-year follow-up. Nine developed epilepsy. Predictors included pH ≤6.8 on day of birth (adjusted odds ratio [OR] 19 [95% ...
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#1Kristen Berry (Cornell University)H-Index: 1
#2Michael F. Pesko (Cornell University)H-Index: 15
Last. Zachary M. Grinspan (Cornell University)H-Index: 18
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SummaryObjective Seizures are a common manifestation of neurologic dysfunction in neonates and carry a high risk for mortality and adverse long-term outcomes. U.S. birth certificates are a potentially valuable source for studying the epidemiology of neonatal seizures. However, the quality of the data is understudied. Methods We reviewed all U.S. birth records from 2003 to 2013 to describe the following: (1) rates of missing data, (2) evidence of underreporting, and (3) effect of the 2003 revisio...
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#1Monica E. Lemmon (Johns Hopkins University)H-Index: 15
#2Renee D. Boss (Johns Hopkins University)H-Index: 24
Last. Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 39
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This study aimed to characterize the circumstances of death in encephalopathic neonates treated with therapeutic hypothermia. Patients who died after or during treatment with therapeutic hypothermia between 2007-2014 were identified. Patient circumstance of death was characterized using an established paradigm. Thirty-one of 229 patients died (14%) at a median of 3 days of life. Most who died were severely encephalopathic on examination (90%) and had severely abnormal electroencephalographic (EE...
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#1Francesco Pisani (University of Parma)H-Index: 29
#2Elena Pavlidis (University of Parma)H-Index: 13
Last. Gaetano Cantalupo (University of Verona)H-Index: 23
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: Seizures are a frequent acute neurological event in the neonatal period. Up to 12 to 18% of all seizures in newborns are due to perinatal stroke and up to 39% of affected children can then develop epilepsy in childhood. We report the case of a young patient who presented stroke-related seizures in the neonatal period and then developed focal symptomatic epilepsy at 15 years of age, and in whom the epileptic focus was found to co-localize with the site of his ischemic brain lesion. Such a prolo...
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#1Christine K. Fox (UCSF: University of California, San Francisco)H-Index: 20
#2Mark T MackayH-Index: 54
Last. Gabrielle deVeber (U of T: University of Toronto)H-Index: 88
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Aim To determine epilepsy risk factors after pediatric stroke. Method A cohort of children with arterial ischemic stroke (birth–18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression. Results Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had ...
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#1Liudmila Kharoshankaya (UCC: University College Cork)H-Index: 4
#2Nathan J. StevensonH-Index: 24
Last. Geraldine B. Boylan (UCC: University College Cork)H-Index: 50
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Aim To examine the relationship between electrographic seizures and long-term outcome in neonates with hypoxic–ischemic encephalopathy (HIE). Method Full-term neonates with HIE born in Cork University Maternity Hospital from 2003 to 2006 (pre-hypothermia era) and 2009 to 2012 (hypothermia era) were included in this observational study. All had early continuous electroencephalography monitoring. All electrographic seizures were annotated. The total seizure burden and hourly seizure burden were ca...
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#1Hannah C. Glass (UCSF: University of California, San Francisco)H-Index: 39
#2Renée A. Shellhaas (UM: University of Michigan)H-Index: 31
Last. Janet S. Soul (Boston Children's Hospital)H-Index: 39
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Objective To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG). Study design We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks' postmenstrual age with clinically suspected seizures and/or electrographic seizures. Subjects were assessed between January 2013 and April 2015 at 7 US tertiary care pediatric centers following the guidelines of the American C...
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#1Christine K. FoxH-Index: 20
#2Hannah C. GlassH-Index: 39
Last. Heather J. FullertonH-Index: 62
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Objectives: To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke. Methods: We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian integrated health care system. We determined incidence and predictors of a remote seizure (unprovoked seizure after neonatal period, defined as 28 days of life) by survival analyses, and...
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#1Francesco Pisani (University of Parma)H-Index: 29
#2Carlotta Facini (University of Parma)H-Index: 7
Last. Elena Pavlidis (University of Parma)H-Index: 13
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Abstract Background With a reported prevalence of 22.2%, seizures in preterm newborns represent an emergent challenge, because they are often related to adverse outcome. The electroclinical features of preterm infants with neonatal seizures were evaluated in order to predict outcome. Methods From 154 newborns with video-EEG confirmed neonatal seizures admitted to Parma University Hospital between January 1999 and December 2012, we collected 76 preterm newborns with neonatal seizures. Outcome was...
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Neonatal seizures pose a clinical challenge in their early detection, acute management, and long-term comorbidities. They are often caused by hypoxic-ischemic encephalopathy and are frequently refr...
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Neonatal encephalopathy (NE) is the most common etiology of acute neonatal seizures - about half of neonates treated with therapeutic hypothermia for NE have EEG-confirmed seizures. These seizures are best identified with continuous EEG monitoring, as clinical diagnosis leads to under-diagnosis of subclinical seizures and over-treatment of events that are not seizures. High seizure burden, especially status epilepticus, is thought to augment brain injury. Treatment, therefore, is aimed at minimi...
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Importance Antiseizure medication (ASM) treatment duration for acute symptomatic neonatal seizures is variable. A randomized clinical trial of phenobarbital compared with placebo after resolution of acute symptomatic seizures closed early owing to low enrollment. Objective To assess whether ASM discontinuation after resolution of acute symptomatic neonatal seizures and before hospital discharge is associated with functional neurodevelopment or risk of epilepsy at age 24 months. Design, Setting, ...
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Seizures are the most common neurological emergency in the neonates, and this age group has the highest incidence of seizures compared with any other period of life. The author provides a narrative review of recent advances in the genetics of neonatal epilepsies, new neonatal seizure classification system, diagnostics, and treatment of neonatal seizures based on a comprehensive literature review (MEDLINE using PubMED and OvidSP vendors with appropriate keywords to incorporate recent evidence), p...
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