Assessment of outcome and prognosis among neonatal seizure patients

Abstract

Background: Paroxysmal changes in neuronal functioning characterize neonatal seizures. In order to diagnose brain damage, serial ultrasonography is crucial.
Objective: To assessment of characteristics, lines of management and outcome among neonatal seizure patients.
Subjects and methods: Sixty neonatal patients with neonatal seizures who were admitted to the neonatal intensive care unit (NICU) at Abul-Reesh and Kasr EL Aini Hospital before or after 28 days of age underwent electroencephalograms (EEGs), cranial ultrasounds, and other laboratory tests as part of this prospective study.
Result: Myoclonic seizures accounted for 22 cases (36.7% of all seizures), followed by mixed types (17 cases, 28.3% of all seizures), subtle types (10 cases, 16.7% of all seizures), and clonic and tonic seizures (8.3% of all seizures) respectively. There was just one infant who experienced a multifocal clonic seizure. 40% of seizures were caused by hypoxic-ischemic encephalopathy, 17% by sepsis, 13% by intraventricular hemorrhage and hypocalcemia, 7% by cerebral hemorrhage, 5% by kernicterus, 3% by metabolic abnormalities, and 2% by meningitis. Myoclonic seizures were associated with poor outcome (death in 59.1%) whereas most of cases with mixed and subtle types were discharged in ratios of (70.6%) and (90%) respectively, however all cases with tonic and multifocal clonic seizures died. We observed poor outcome among the polytherapy use of certain anticonvulsant drugs especially levetiracetam, lamotrigine, and midazolam.
Conclusion: While the prognosis is dismal for seizures that have persisted for a long period, it improves when neonatal seizures are controlled early on. It is possible to detect mild to moderate brain lesions using a combination of neuroimaging and newborn EEG.