Doğumsal Hi̇poksi̇k İskemi̇k Ensefalopati̇ye Bağlı Olmayan Term Yeni̇doğan Konvülzi̇yonlarında Psi̇komotor Geri̇li̇k ve Epi̇lepsi̇ Geli̇şi̇m Risk Faktörleri

Abstract

Amaç: Yenidoğan konvulziyonları, yenidoğan döneminde akut nörolojik hastalıkların en yaygın semptomlarından biridir. Hastalarda ölüm, mental retardasyon ve postneonatal epilepsi riskini arttırdığı bilinmektedir. Bu çalışmada sebebi doğumsal hipoksik iskemik ensefalopati olmayan ve hastanemizde yenidoğan konvulziyonu sebebiyle takip edilmiş hastalarda etyolojik faktörler ile nörogelişim ve epilepsi ilişkisi ve risk faktörlerinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Bu çalışmaya hastanemiz nöroloji polikliniğinde takipli, Ocak 2010 - Aralık 2014 tarihleri arasında miadında doğan, doğumsal hipoksik iskemik ensefalopati öyküsü olmayıp, yenidoğan döneminde nöbet öyküsü olan, en az 1 yıl takibimizde kalan hastalar dahil edildi.

Bulgular: Çalışmaya 49 hasta dahil edildi. İlk başvuru sırasında saptanabilen en sık etyolojik faktör, 11 (%40.74) hastada saptanan hipoglisemiydi. İzlemde hastaların %22.4’ünde (n=11) postneonatal epilepsi geliştiği görüldü. Bayley II testleri anormal saptanan 7 hastanın 4’ünde epilepsi geliştiği belirlendi. Yenidoğan döneminde başlanan tedaviye yanıtın olmaması, anormal nörolojik muayene bulgularının varlığı ve izlemde anormal EEG bulgularının olması, hastalarda postneonatal epilepsi gelişimi için risk faktörleri arasındaydı.

Sonuç: Hipoglisemi, yenidoğan nöbetlerinde saptanabilen ve tedavi edilebilen sebeplerden bir tanesidir. Anormal nörolojik muayene bulguları, başlanan tedaviye alınan yanıtlar ve izlem EEG bulguları epilepsi gelişimi ile ilişkili görüldü. Bu konuda yapılmış olan çalışmaların çoğu, kısa gözlem süreleri sebebiyle sınırlıdır. Yenidoğan konvulziyonları ve postneonatal epilepsi gelişimi açısından daha fazla prognostik faktör belirlemek için daha fazla çalışmaya ihtiyaç vardır.

Keywords

• Yenidoğan konvülziyonları
• hipoglisemi
• postneonatal epilepsi

Postneonatal Epilepsy and Psychomotor Developmental Retardation Risk Factors in Term Neonatal Convulsions Without Hypoxic Ischemic Encephalopathy

Abstract

Objective: Neonatal convulsions may be an early sign of brain injury and the presence of convulsions in the neonatal period has been associated with long-term sequelaes such as mental retardation, postnatal epilepsy and death. We aimed to determine associations of etiological factors with neurodevelopment and postneonatal epilepsy and evaluate the risk factors in newborns with neonatal convulsions that were not related to hypoxic-ischemic encephalopathy.

Material and Methods: This study included full-term infants who were born between January 2010 and December 2014 and had neonatal convulsion history, had no history of hypoxic-ischemic encephalopathy and were followed for at least 1 year at our neurology clinic.

Results: Forty-nine patients were included to the study. Among the identified etiologies on first clinical visit, hypoglycemia was the most common cause which was presented in 11 (40.74%; 11/27 patients) patients. During follow-up, 22.4% (n=11) of patients developed postneonatal epilepsy. In 4 of 7 patients with abnormal Bayley II test results, epilepsy developed in the follow-up. The risk for development of postneonatal epilepsy was significantly associated with abnormal neurological findings, such as cerebral palsy or significant delays in developmental stages; being not benefited from acute treatment and follow-up abnormal EEG findings of the patients.

Conclusion: Hypoglycemia should be primarily investigated and treated in term neonatal seizures without hypoxia. Abnormal neurological findings, being not benefited from the acute treatment and follow-up EEG findings were associated with developing epilepsy. In the literature, most of the studies were limited due to short follow-up periods. More information about prognostic factors in neonatal convulsions and the occurrence of postneonatal epilepsy is needed.

Keywords

• Neonatal seizures
• hypoglycemia in newborn seizures
• postneonatal epilepsy

References

1. References 1. McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neurodevelopmental outcome. Neurology. 2000;55(4):506-13.
2. 2. Scher MS, Aso K, Beggarly ME, Hamid MY, Steppe DA, Painter MJ. Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae. Pediatrics. 1993;91(1):128-34.
3. 3. Chapman KE, Raol YH, Brooks-Kayal A. Neonatal seizures: controversies and challenges in translating new therapies from the lab to the isolette. Eur J Neurosci. 2012;35(12):1857-65.
4. 4. Connell J, Oozeer R, de Vries L, Dubowitz LM, Dubowitz V. Continuous EEG monitoring of neonatal seizures: diagnostic and prognostic considerations. Arch Dis Child. 1989;64(4 Spec No):452-8.
5. 5. Khan RL, Nunes ML, Garcias da Silva LF, da Costa JC. Predictive value of sequential electroencephalogram (EEG) in neonates with seizures and its relation to neurological outcome. J Child Neurol. 2008;23(2):144-50.
6. 6. Forsgren L, Beghi E, Oun A, Sillanpaa M. The epidemiology of epilepsy in Europe - a systematic review. Eur J Neurol. 2005;12(4):245-53.
7. 7. Ronen GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures: a population-based study. Neurology. 2007;69(19):1816-22.
8. 8. Pisani F, Piccolo B, Cantalupo G, Copioli C, Fusco C, Pelosi A, et al. Neonatal seizures and postneonatal epilepsy: a 7-y follow-up study. Pediatr Res. 2012;72(2):186-93.

9. 9. Volpe JJ. Neurology of the Newborn. Philadelphia, PA: Saunders, 2008:178–214.
10. 10. Epstein CM. Guidelines 2: minimum technical standards for pediatric electroencephalography. J. Clin Neurophysiol. 2006;23(2):92-6.
11. 11. Garfinkle J, Shevell MI. Prognostic factors and development of a scoring system for outcome of neonatal seizures in term infants. Eur J Paediatr Neurol. 2011;15(3):222-9.
12. 12. Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J, et al. The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants. Pediatrics. 2006;117(4):1270-80.
13. 13. Pisani F, Facini C, Pelosi A, Mazzotta S, Spagnoli C, Pavlidis E. Neonatal seizures in preterm newborns: A predictive model for outcome. Eur J Paediatr Neurol. 2016;20(2):243-51.
14. 14. Holden KR, Mellits ED, Freeman JM. Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics. 1982;70(2):165-76.
15. 15. Volpe JJ. Neonatal seizures. In: Volpe JJ, editor. Neurology of the newborn. 5th ed. Philadelphia: WB Saunders; 2008, p. 203-4.
16. 16. Mellits ED, Holden KR, Freeman JM. Neonatal seizures. II. A multivariate analysis of factors associated with outcome. Pediatrics. 1982;70(2):177-85.
17. 17. Scher MS. Neonatal seizures and brain damage. Pediatr Neurol. 2003;29(5):381-90.
18. 18. Pisani F, Facini C, Pavlidis E, Spagnoli C, Boylan G. Epilepsy after neonatal seizures: literature review. Eur J Paediatr Neurol. 2015;19(1):6-14.
19. 19. Mizrahi EM WKSnsIRJ, Bureau M, Dravet C, Genton P, Tassinari CA, Wolf P, et al. Epileptic syndromes in infancy, childhood and adolescence. Montrouge, France: John Libbey Eurotext; 2005. p. 17-38.
20. 20. Lai YH, Ho CS, Chiu NC, Tseng CF, Huang YL. Prognostic factors of developmental outcome in neonatal seizures in term infants. Pediatr Neonatol. 2013;54(3):166-72.
21. 21. Painter MJ, Sun Q, Scher MS, Janosky J, Alvin J. Neonates with seizures: what predict development? J Child Neurol. 2012;27:1022-1026.
22. 22. Ortibus EL, Sum JM, Hahn JS. Predictive value of EEG for outcome and epilepsy following neonatal seizures. Electroencephalogr Clin Neurophysiol. 1996;98(3):175-85.
23. 23. Yildiz EP, Tatli B, Ekici B, Eraslan E, Aydinli N, Caliskan M, et al. Evaluation of etiologic and prognostic factors in neonatal convulsions. Pediatr Neurol. 2012;47(3):186-92.