Seizure recurrence in infants with neonatal convulsions a follow-up study: estudo evolutivo

Gherpelli, J. L. D.; Paz, J. A.; Leone, C.R.; Ramos, J.L.A.; Diament, A.J.

doi:10.1590/S0004-282X1992000100006

Abstracts

Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEC, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.

newborn; neonatal convulsion; seizure recurrence

Vinte e três crianças com crises convulsivas neonatais foram seguidas, prospectivamente, até idade em média de 11 meses. O peso ao nascimento variou de 1700 a 4230 gramas; 2 eram pré-termo; 17 eram meninos e 6, meninas. A encefalopatia hipóxico-isquê-mica foi a etiologia mais frequente (82,6%). Houve predomínio das crises clônicas focais, presentes em 7/16 crianças nas quais o tipo de crise foi identificado. Todas as crianças foram submetidas a exame neurológico e avaliação eletrencefalográfica e, em 18 delas, foi realizado exame ultrassonográfico (US) de crânio durante o seguimento ambulatorial. A medicação anticonvulsivante foi interrompida se o EEG e o exame neurológico eram normais no seguimento. A recorrência de crises foi observada em 7/23 crianças (30%). Houve relação estatisticamente significante entre a recorrência de crises e anormalidades do exame neurológico, EEG e US de crânio. Concluímos que as crianças com crises convulsivas neonatais podem permanecer sem medicação anticonvulsivante desde que não apresentem anormalidades ao exame neurológico, ao EEG e ao US de crânio.

recém-nascido; convulsão neonatal; recorrência de convulsão

J. L. D. Gherpelli^I; J. A. Paz^I; C.R. Leone^II; J.L.A. Ramos^II; A.J. Diament^I

^IChild Neurologist. Department of Neurology, Clinics Hospital of University of São Paulo Medical School

^IINeonatologist. Department of Neurology, Clinics Hospital of University of São Paulo Medical School

SUMMARY

Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEC, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.

Key words: newborn, neonatal convulsion, seizure recurrence.

RESUMO

Vinte e três crianças com crises convulsivas neonatais foram seguidas, prospectivamente, até idade em média de 11 meses. O peso ao nascimento variou de 1700 a 4230 gramas; 2 eram pré-termo; 17 eram meninos e 6, meninas. A encefalopatia hipóxico-isquê-mica foi a etiologia mais frequente (82,6%). Houve predomínio das crises clônicas focais, presentes em 7/16 crianças nas quais o tipo de crise foi identificado. Todas as crianças foram submetidas a exame neurológico e avaliação eletrencefalográfica e, em 18 delas, foi realizado exame ultrassonográfico (US) de crânio durante o seguimento ambulatorial. A medicação anticonvulsivante foi interrompida se o EEG e o exame neurológico eram normais no seguimento. A recorrência de crises foi observada em 7/23 crianças (30%). Houve relação estatisticamente significante entre a recorrência de crises e anormalidades do exame neurológico, EEG e US de crânio. Concluímos que as crianças com crises convulsivas neonatais podem permanecer sem medicação anticonvulsivante desde que não apresentem anormalidades ao exame neurológico, ao EEG e ao US de crânio.

Palavras chave: recém-nascido, convulsão neonatal, recorrência de convulsão.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. José Luiz D. Gherpelli Departamento de Neurologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - Caixa Postal 8091 - 01065 São Paulo SP - Brasil.

1. Bergman I, Painter MJ, Hirsh RP, Crurine PK, Dawid R. Outcome in neonates with convulsions treated in an intensive care unit. Ann Neurol 1983, 14:642-647.
2. Brod SA, Ment LR, Ehrenkranz RA, Bridges S. Predictors of success for drug discontination following neonatal seizures. Pediatr Neurol 1988, 4:13-17.
3. Calciolari G, Perlman MB, Volpe JJ. Seizures in the neonatal intensive care unit of the 1980s. Clin Pediatr 1988, 27:119-123.
4. Clancy RR, Legido A, Lewis D. Occult neonatal seizures. Epilepsia 1988, 29:256-261.
5. Curtis PD, Matthews TG, Clarke TA, Darling M, Crowley P, Griffin E, O' Connell P, Gorman W, O' Brien N, O' Herlih YC, O' Regan O. Neonatal seizures: the Dublin collaborative study. Arch Dis Child 1988, 63:1065-1068.
6. Ellison PH. Management of seizures in the high-risk infant. Clin Perinatol 1984, 11:175-188.
7. Ellison PH, Largent JA, Bahr JP. A scoring system to predict outcome following neonatal seizures. J Pediatr 1981, 99:455-459.
8. Eriksson M, Zetterstrom R. Neonatal convulsions: incidence and causes in the Stockholm area. Acta Paediatr Scand 1979, 68:807-811.
9. Eyre JA, Oozer RC, Wilkinson AR. Diagnosis of neonatal seizure by continuous recording and rapid analysis of the electroencephalogram. Arch Dis Child 1983, 58:785-790.
10. Gal P, Boer HR. Early discontinuation of anticonvulsants after neonatal seizures. S Med J 1982, 75:298-300.
11. Mizrahi EM, Kellaway P. Characterization and classification of neonatal seizures. Neurology 1987, 37:1837-1844.
12. Rowe JC, Holmes GL, Hafford J, Baboval D, Robinson S, Philips A, Rosenkrantz T, Raye J. Prognostic value of the electroencephalogram in term and preterm infants following neonatal seizures. Electroenceph Clin Neurophysiol 1985, 60:183-196.
13. Scarpa P, Chierici R, Tamisari L, Fortini C, Volpato S. Criteria for discontinuing neonatal seizure therapy: a long-term appraisal. Brain Dev 1983, 5:541-548.
14. Scher MS, Painter MJ. Controversies concerning neonatal seizures. Pediatr Clin N Am 1989, 36:281-310.
15. Seay AR, Bray PF. Significance of seizures in infants weighing less than 2, 500 grams. Arch Neurol 1977, 34:381-382.
16. Volpe JJ. Neonatal seizures. In Volpe JJ (ed.): Neurology of the Newborn. Ed 2. Philadelphia: Saunders, 1987, p 129-157.
17. Watanabe K, Kuroyanagi M, Hara K, Miyazaki S. Neonatal seizures and subsequent epilepsy. Brain Dev 1982. 4:341-346.

Seizure recurrence in infants with neonatal convulsions a follow-up study

Recorrência de crises convulsivas em crianças com convulsões neonatais: estudo evolutivo

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Mar 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bergman I, Painter MJ, Hirsh RP, Crurine PK, Dawid R. Outcome in neonates with convulsions treated in an intensive care unit. Ann Neurol 1983, 14:642-647.

[2] 2. Brod SA, Ment LR, Ehrenkranz RA, Bridges S. Predictors of success for drug discontination following neonatal seizures. Pediatr Neurol 1988, 4:13-17.

[3] 3. Calciolari G, Perlman MB, Volpe JJ. Seizures in the neonatal intensive care unit of the 1980s. Clin Pediatr 1988, 27:119-123.

[4] 4. Clancy RR, Legido A, Lewis D. Occult neonatal seizures. Epilepsia 1988, 29:256-261.

[5] 5. Curtis PD, Matthews TG, Clarke TA, Darling M, Crowley P, Griffin E, O' Connell P, Gorman W, O' Brien N, O' Herlih YC, O' Regan O. Neonatal seizures: the Dublin collaborative study. Arch Dis Child 1988, 63:1065-1068.

[6] 6. Ellison PH. Management of seizures in the high-risk infant. Clin Perinatol 1984, 11:175-188.

[7] 7. Ellison PH, Largent JA, Bahr JP. A scoring system to predict outcome following neonatal seizures. J Pediatr 1981, 99:455-459.

[8] 8. Eriksson M, Zetterstrom R. Neonatal convulsions: incidence and causes in the Stockholm area. Acta Paediatr Scand 1979, 68:807-811.

[9] 9. Eyre JA, Oozer RC, Wilkinson AR. Diagnosis of neonatal seizure by continuous recording and rapid analysis of the electroencephalogram. Arch Dis Child 1983, 58:785-790.

[10] 10. Gal P, Boer HR. Early discontinuation of anticonvulsants after neonatal seizures. S Med J 1982, 75:298-300.

[11] 11. Mizrahi EM, Kellaway P. Characterization and classification of neonatal seizures. Neurology 1987, 37:1837-1844.

[12] 12. Rowe JC, Holmes GL, Hafford J, Baboval D, Robinson S, Philips A, Rosenkrantz T, Raye J. Prognostic value of the electroencephalogram in term and preterm infants following neonatal seizures. Electroenceph Clin Neurophysiol 1985, 60:183-196.

[13] 13. Scarpa P, Chierici R, Tamisari L, Fortini C, Volpato S. Criteria for discontinuing neonatal seizure therapy: a long-term appraisal. Brain Dev 1983, 5:541-548.

[14] 14. Scher MS, Painter MJ. Controversies concerning neonatal seizures. Pediatr Clin N Am 1989, 36:281-310.

[15] 15. Seay AR, Bray PF. Significance of seizures in infants weighing less than 2, 500 grams. Arch Neurol 1977, 34:381-382.

[16] 16. Volpe JJ. Neonatal seizures. In Volpe JJ (ed.): Neurology of the Newborn. Ed 2. Philadelphia: Saunders, 1987, p 129-157.

[17] 17. Watanabe K, Kuroyanagi M, Hara K, Miyazaki S. Neonatal seizures and subsequent epilepsy. Brain Dev 1982. 4:341-346.