NEONATAL SEIZURES;

TYPES, ETIOLOGY AND LONG TERM NEURODEVELOPMENTAL OUTCOME AT A TERTIARY CARE HOSPITAL

Abstract

Objective: To study the types, etiology and long term neurodevelopmental
outcome in neonates with seizures. Study Design: A descriptive cross-sectional study. Place
and Duration of Study: PNS Shifa Naval hospital Karachi from Jan 2011 to Feb 2014. Study
Population: Ninety six neonates of either gender presented with seizures at NICU PNS Shifa
Naval hospital Karachi were studied. Method: All neonates with seizures were evaluated.
The seizures were classified according to the simiology. They were investigated according to
NICU protocol to confirm the underlying diagnosis and timely management. The patients after
discharge were regularly followed up for one year to assess the long term neurodevelopmental
outcome. Results: A total of 96 neonates with seizures were studied and it was observed
that 60 (62.5%) were male babies and 56 (58.33%) were term with a male to female ratio of
1.6:1. Majority of the neonatal seizures were seen in 1stweek of life (85%). The most common
type of seizures was clonic 40 (41.67%) followed by subtle 20 (20.84%), mixed 16 (16.67%),
tonic 10 (10.41%), myoclonic 5 (5.20%) and unclassified 5 (5.20%). Antiepileptics were used
in 82 (85.41%) patients. Phenobarbitone 49 (59.76%) was most commonly prescribed drug.
The most common cause of seizures was birth asphyxia 48 (50%) followed by metabolic 16
(16.68%), sepsis 10 (10.41%), intracranial hemorrhage 6 (6.25%), bilirubin encephalopathy 4
(4.16%), inborn errors of metabolism 2 (2.08%), birth trauma 2 (2.08%) and unknown etiology 5
(5.20%). 25 (26.04%) patients develop adverse neurodevelopmental outcome i.e. cerebral palsy
with epilepsy 10 (40%) and cerebral palsy without epilepsy 05 (20%), developmental delay 10
(40%). Mortality in the study was 12 (12.5%). Conclusions: Clonic seizures are commonest
in neonates apart from infants and children who have GTCS. The most common etiology of
seizures in neonates is birth asphyxia. Phenobarbitone is still the most commonly prescribed
antiepileptic. Quick assessment, timely diagnosis and aggressive management according to
the etiology are necessary to prevent the morbidity and mortality associated with neonatal
seizures. Long term neurodevelopmental outcome is worse in patients with birth asphyxia
especially with low Apgar score at 5 minutes. Normal delivery and birth asphyxia were the major
risk factors for cerebral palsy