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Lugli L, Bariola MC, Guidotti I, Pugliese M, Roversi MF, Bedetti L, Della Casa Muttini E, Miselli F, Ori L, Lucaccioni L, Bertoncelli N, Rossi K, Crestani S, Bergonzini P, Iughetti L, Ferrari F, Berardi A. Neurodevelopmental outcome of neonatal seizures: A longitudinal study. Eur J Paediatr Neurol 2024; 49:17-26. [PMID: 38324990 DOI: 10.1016/j.ejpn.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Neonatal seizures (NS) are the most common neurological emergency in the neonatal period. The International League Against Epilepsy (ILAE) proposed a new classification of NS based on semiology and highlighted the correlation between semiology and aetiology. However, neurodevelopmental outcomes have not been comprehensively evaluated based on this new classification. AIMS To evaluate neurodevelopmental outcomes and potential risk factors for severe outcomes in NS. METHODS Patients with video electroencephalogram confirmed NS were evaluated. Seizure aetiology, cerebral magnetic resonance imaging (MRI) data, background electroencephalograms data, general movements, and neurodevelopmental outcomes were analysed. Severe outcomes were one of the following: death, cerebral palsy, Griffiths developmental quotient <70, epilepsy, deafness, or blindness. RESULTS A total of 74 neonates were evaluated: 62 (83.8 %) with acute provoked NS (primarily hypoxic-ischaemic encephalopathy), and 12 (16.2 %) with neonatal-onset epilepsies (self-limited neonatal epilepsy, developmental and epileptic encephalopathy, cerebral malformations). Of these, 32 (43.2 %) had electrographic seizures, while 42 (56.7 %) had electroclinical seizures - 38 (90.5 %) were motor (42.1 % clonic) and 4 (9.5 %) were non-motor phenomena. Severe outcomes occurred in 33 of the 74 (44.6 %) participants. In multivariate analysis, neonatal-onset epilepsies (odds ratio [OR]: 1.3; 95 % confidence interval [CI]: 1.1-1.6), status epilepticus (OR: 5.4; 95 % CI: 1.5-19.9), and abnormal general movements (OR: 3.4; 95 % CI: 1.9-7.6) were associated with severe outcomes. CONCLUSIONS At present, hypoxic-ischaemic encephalopathy remains the most frequent aetiology of NS. The prognosis of neonatal-onset epilepsies was worse than that of acute provoked NS, and status epilepticus was the most predictive factor for adverse outcomes.
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Affiliation(s)
- Licia Lugli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy.
| | | | - Isotta Guidotti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy
| | | | | | - Luca Bedetti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy
| | | | - Francesca Miselli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy
| | - Luca Ori
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Mother-Child Department, University Hospital of Modena, Italy
| | | | - Katia Rossi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy
| | - Sara Crestani
- Postgraduate School of Pediatrics, Department of Medical and Surgical Sciences for Mother, Children and Adults, University of Modena and Reggio Emilia, Italy
| | - Patrizia Bergonzini
- Pediatric Unit, Mother-Child Department, University Hospital of Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Mother-Child Department, University Hospital of Modena, Italy; Postgraduate School of Pediatrics, Department of Medical and Surgical Sciences for Mother, Children and Adults, University of Modena and Reggio Emilia, Italy
| | - Fabrizio Ferrari
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy
| | - Alberto Berardi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Italy
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