Neonatal Seizures Linked to Increased Epilepsy Risk

TOPLINE:

Children with neonatal seizures had a 20.4% cumulative risk for epilepsy by age 22, whereas those without seizures had a risk of 1.15%, a new cohort study found. The risk persisted throughout childhood.

METHODOLOGY:

• This nationwide register-based cohort study included 1,294,377 children born in Denmark between 1997 and 2018, of whom 1998 were neonatal survivors with neonatal seizures.
• Analysis included data from the Danish Medical Birth Register, Danish Register of Causes of Death, Danish Migration Register, and Danish National Patient Registry, linked via unique Danish personal identification numbers.
• The primary outcome measure was epilepsy, and the secondary outcome was febrile seizures.

TAKEAWAY:

• The cumulative risk for epilepsy was significantly higher in children with neonatal seizures than in those without (20.4% vs 1.15%, adjusted hazard ratio [aHR], 27.11; 95% CI, 24.42-30.09). The risk persisted across age intervals: 0-1 years (11.4%), 1-5 years (15.9%), 5-10 years (19.0%), and 10-22 years (20.4%).
• Children with cerebral infarction, haemorrhage, kernicterus, or cerebral malformations (aHR, 2.49; 95% CI, 1.98-3.14) and those with low Apgar scores (aHR, 1.49; 95% CI, 1.12-1.98) had a higher risk for epilepsy than those with seizures of unknown aetiology.
• The median age at epilepsy diagnosis was 5 months in children with neonatal seizures, whereas it was 4 years 6 months in those without.
• The risk for febrile seizures without subsequent epilepsy was also higher in children with neonatal seizures than in those without (6.2% vs 3.8%; aHR, 1.61; 95% CI, 1.35-1.94).

IN PRACTICE:

“Our study confirms a substantial risk of epilepsy after neonatal seizures in neonatal survivors, with the highest risk observed in the first year of life but persisting into adolescence. Structural brain abnormalities were associated with the greatest risk of epilepsy,” the authors wrote.

SOURCE:

The study was led by Jeanette Tinggaard, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. It was published online on February 19 in Developmental Medicine & Child Neurology.

LIMITATIONS:

The study’s reliance on routine diagnoses and hospital admission reports may have led to an underestimation of true neonatal seizure cases, particularly electrographic-only seizures or milder manifestations. Variability in EEG availability and evolving diagnostic criteria may have influenced classification. The use of Apgar scores as a proxy for perinatal asphyxia may have introduced bias. Additionally, register-based diagnoses of epilepsy may have lacked full adherence to International League Against Epilepsy criteria.

DISCLOSURES:

The study did not receive any funding. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.