Fox CK, et al. Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke. Neurology. 2016. This analysis of a Kaiser Permanente database had 87 children with perinatal strokes. Those who had seizures during the neonatal period had far higher risk of later epilepsy, including refractory epilepsy requiring multiple medications. Of the whole sample more than half had at least one seizure in later life, and half of those had refractory epilepsy. The risk of both was about twice as high if you had neonatal seizures.
Hart AR, et al. Neonatal seizures—part 1: Not everything that jerks, stiffens and shakes is a fit. Archives of disease in childhood – Education & practice edition. 2015;100(4):170-5. As this review article notes, diagnosing seizures is difficult. Previous evidence has shown that about half of what we think are “fits” (in the good old English terminology) are not, and we only recognize about half of actual seizures as diagnosed by routine clinical monitoring. Some studies show we are even worse than that.
Glass HC, et al. Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study. The Journal of pediatrics. 2016. This was a prospective multi-center cohort study, with newborns who were considered at risk for convulsions all being monitored by continuous video EEG. Most of the 426 included babies had HIE, or strokes, or intracranial hemorrhages. Many of the babies had large numbers of seizures and 16% had status epilepticus. Half of the survivors still had abnormal clinical signs at discharge, with another 17% dying. Those that had the most seizures were more likely to die or be abnormal at discharge.
Continuous video-EEG is clearly now an essential tool in any tertiary NICU, and we need to find ways to recognize the seizures faster, and treat them more effectively.