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Neonatal status epilepticus vs recurrent neonatal seizures

Clinical findings and outcome

From the Child Neuropsychiatric Unit, Neuroscience Department, University of Parma, Italy (F.P., C.F., L.S.); and Pediatric Neurology Unit, Tor Vergata University, Rome, Italy (C.C.).

Address correspondence and reprint requests to Dr. Francesco Pisani, Via Gramsci, 14, 43100 Parma, Italy

Background: Although most children with status epilepticus have a good prognosis, its effects on newborns are unclear.

Objective: We compare the neurodevelopmental consequences of recurrent seizures and status epilepticus in newborns.

Methods: One hundred six newborns with video-EEG–confirmed seizures, consecutively admitted to the neonatal intensive care unit of the University of Parma between January 1999 and December 2004, were enrolled in the study. Fifty-one were preterm and 55 were full-term newborns. Neonatal status epilepticus was defined as continuous seizure activity for at least 30 minutes or recurrent seizures lasting a total of >30 minutes without definite return to the baseline neurologic condition of the newborn between seizures. Neurologic outcome was assessed at 24 months of corrected age.

Results: Thirty-six newborns had a normal outcome, 20 died, and 50 presented an adverse outcome. All but 1 of the 26 subjects with neonatal status epilepticus had an adverse outcome. Birth weight, severely abnormal cerebral ultrasound scans, and status epilepticus were independent predictors of abnormal outcome. Depending on gestational age (GA), neonatal status epilepticus seems to be a risk factor of adverse outcome in full-term newborns (GA 37 weeks: odds ratio [OR] 20.312, 95% CI 2.417 to 170.679, p = 0.006), and a risk factor of epilepsy in early preterm and full-term newborns (GA 29 weeks: OR 10.500, 95% CI 1.211 to 91.026, p = 0.033; GA 37 weeks: OR 6.517, 95% CI 1.321 to 32.148, p = 0.021).

Conclusion: Newborns with status epilepticus are at high risk of severe neurologic disability and postneonatal epilepsy. This is particularly evident in early preterm and full-term infants.

Abbreviations: GA = gestational age; IVH = intraventricular hemorrhage; NICU = neonatal intensive care unit; NS = not significant; OR = odds ratio; PVL = periventricular leukomalacia; RS = recurrent seizures; SE = status epilepticus; US = ultrasound.

francesco.pisani{at}unipr.it

Disclosure: The authors report no conflicts of interest.

Received February 10, 2007. Accepted in final form May 31, 2007.

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