Abstracts

Rationale: Most neonatal seizures are symptomatic of acute brain injury; there is disagreement about how long to continue anti-epileptic drug (AED) treatment after acute symptomatic seizures resolve. This prospective, observational study sought to determine the risk of ongoing seizures after hospital discharge in a cohort of neonates with MRI-confirmed acute brain injury.Methods: This single-center, prospective study enrolled consecutive neonates with acute brain injury admitted to our institution’s neonatal intensive care unit (NICU) between January and November 2014. Eligible neonates had a diagnosis of acute brain injury confirmed by neuroimaging, defined as ischemic or hemorrhagic injury on MRI, CT, or head ultrasound with features consistent with injury occurring in the preceding 7 days. Parental consent was obtained for all participants. Clinical practice at our institution is to perform video EEG monitoring in these patients for at least 24 hours to evaluate for electrographic seizures. Upon enrollment, clinical variables were extracted through chart review. EEGs were interpreted by a single pediatric neurophysiologist. Follow up was obtained through chart review and corroborated by phone calls to families at both 6 weeks and 6 months of age.Results: During the study period, 36 neonates were eligible; 24 consented to participate. The most common diagnosis was hypoxic ischemic encephalopathy (n=18, 75%); other diagnoses were intracranial hemorrhage (n=4, 16.7%), arterial ischemic stroke (n=1, 4%), and sinus venous thrombosis (n=1, 4%). Overall, 12 subjects (50%) had acute symptomatic seizures during NICU admission. Seizures began at a mean age of 3.5 days (median 0.6 days), and continued until a mean of 8.5 days of age (median 4.7 days). Of the 12 subjects with seizures, 7 were discharged home on continued AED treatment, while 3 had AED stopped prior to NICU discharge. Two subjects with seizures died prior to NICU discharge. Among the 7 neonates discharged home on AEDs, 6 had AEDs discontinued during the follow up period, with median 3 months’ duration of any AED treatment after discharge. At 6-month follow up, none of the 22 surviving subjects had seizure after hospital discharge, regardless of presence of acute symptomatic seizures or duration of AED treatment.Conclusions: Our prospective cohort of neonates with acute brain injury found that while half had seizures in the acute period, during NICU admission, none had seizures following hospital discharge. This was true both for those continued on AEDs for an initial period after discharge, as well as for those who were not continued on AED at NICU discharge. These data suggest there is a low risk of ongoing seizures after hospital discharge for neonates with acute brain injury, even following acute symptomatic seizures. Routine continuation of AEDs to prevent seizures in the months after hospital discharge may not be warranted. Longer-term follow-up of this cohort is ongoing. This study was supported by the Epilepsy Foundation’s Research Grants program, funded by the American Epilepsy Society.