Morbidity of Post-Neonatal Epilepsy through Childhood Among Survivors of Acute Provoked Neonatal Seizures
Abstract number :
1.351
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2024
Submission ID :
1295
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Adam Numis, MD – University of California, San Francisco
Hannah Glass, MDCM, MAS – University of California, San Francisco
Courtney Wusthoff, MD – Stanford University
Janet Soul, MDCM – Boston Children's Hospital
Monica Lemmon, MD – Duke University
Giulia Benedetti, MD – University of Michigan
Nancy McNamara, MD – University of Michigan
Madison Berl, PhD – Children's National Hospital
Cameron Thomas, MD – Cincinnati Children's Hospital Medical Center
Catherine Chu, MD – Massachusetts General Hospital/Harvard Medical School
Shavonne Massey, MD, MSCE – Children's Hospital of Philadelphia
Tayyba Anwar, MD – Children's National Hospital
Julie Sturza, MPH – University of Michigan
Linda Franck, RN, PhD – University of California, San Francisco
Chuck McCulloch, PhD, MS, MA – University of California, San Francisco
Renée Shellhaas, MD, MS – Washington University in St. Louis
Rationale: Neonatal seizures are an established risk factor for childhood epilepsy. Historically, the incidence of epilepsy after acute provoked neonatal seizures was best studied in the first year of life; few long-term prospective studies evaluate ongoing risk through childhood. Similarly, little is known about the range of epilepsy phenotypes and associated morbidity among childhood survivors of acute neonatal seizures. We aimed to fill these gaps through a multicenter, prospective observational study with 8 years of longitudinal follow-up.
Methods: In a prospective multicenter cohort study, we enrolled neonates with acute provoked neonatal seizures born 7/2015 to 3/2018 across nine Neonatal Seizure Registry sites. Post-neonatal epilepsy was defined using ILAE criteria, documented via parent report, and corroborated by medical record review. Participants’ families were contacted at ages 12, 18, and 24 months; and were invited for ongoing follow-up annually through 8 years of age. Cox regression was used to assess epilepsy-free survival. Participiants were censored at loss to follow-up or end of the study period.
Results: Among 282 survivors of acute provoked neonatal seizures, 47 developed post-neonatal epilepsy with a cumulative incidence of 20% to 8 years of age (95% confidence interval (CI): 15-26%). Among children with epilepsy, 38 of 47 (81%) were diagnosed by 24 months corrected age (95% CI: 69-91%) and 45 (98%) by 5 years of age (95% CI: 90-100%). Several risk factors for epilepsy were identified in univariate analyses (Table 1). In multivariate cox regression, prematurity was associated with the greatest increase in risk of epilepsy over time (hazard ratio 3.9, 95% CI: 2.1-7.3, Figure 1). Other significant risk factors from the neonatal admission included ≥3 days of EEG-confirmed seizures, deep gray nuclei and/or brainstem injury on MRI, and abnormal neurological exam at discharge. The prevalence of epilepsy among children with: 0 risk factors = 6/112 (5%); 1 risk factor = 41/182 (23%); 2 risk factors = 31/74 (42%); 3 risk factors = 7/11 (64%); 4 risk factors = 1/1 (100%). Among the 47 children diagnosed with epilepsy, 29 (64%) were also diagnosed with cerebral palsy, 13 (28%) with moderate or severe functional impairment (Vineland-3 < 70), 13 (28%) were diagnosed with infantile epileptic spasms syndrome, and 3 (6%) with Lennox-Gastaut syndrome. Thirteen of 47 (28%) reported admission to an intensive care unit for status epilepticus.
Clinical Epilepsy