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Risk for infantile spasms after acute symptomatic neonatal seizures.

Publication ,  Journal Article
Glass, HC; Grinspan, ZM; Li, Y; McNamara, NA; Chang, T; Chu, CJ; Massey, SL; Abend, NS; Lemmon, ME; Thomas, C; McCulloch, CE; Shellhaas, RA ...
Published in: Epilepsia
December 2020

OBJECTIVE: Infantile spasms (IS) is a severe epilepsy in early childhood. Early treatment of IS provides the best chance of seizure remission and favorable developmental outcome. We aimed to develop a prediction rule to accurately predict which neonates with acute symptomatic seizures will develop IS. METHODS: We used data from the Neonatal Seizure Registry, a prospective, multicenter cohort of infants with acute symptomatic neonatal seizures born from July 2015 to March 2018. Neonates with acute symptomatic seizures who received clinical electroencephalography (EEG) and magnetic resonance imaging (MRI) and were younger than 2 years of age at the time of enrollment were included. We evaluated the association of neonatal EEG, MRI, and clinical factors with subsequent IS using bivariate analysis and best subsets logistic regression. We selected a final model through a consensus process that balanced statistical significance with clinical relevance. RESULTS: IS developed in 12 of 204 infants (6%). Multiple potential predictors were associated with IS, including Apgar scores, EEG features, seizure characteristics, MRI abnormalities, and clinical status at hospital discharge. The final model included three risk factors: (a) severely abnormal EEG or ≥3 days with seizures recorded on EEG, (b) deep gray or brainstem injury on MRI, and (c) abnormal tone on discharge exam. The stratified risk of IS was the following: no factors 0% (0/82, 95% confidence interval [CI] 0%-4%), one or two factors 4% (4/108, 95% CI 1%-9%), and all three factors 57% (8/14, 95% CI 29%-83%). SIGNIFICANCE: IS risk after acute symptomatic neonatal seizures can be stratified using commonly available clinical data. No child without risk factors, vs >50% of those with all three factors, developed IS. This risk prediction rule may be valuable for clinical counseling as well as for selecting participants for clinical trials to prevent post-neonatal epilepsy. This tailored approach may lead to earlier diagnosis and treatment and improve outcomes for a devastating early life epilepsy.

Duke Scholars

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Published In

Epilepsia

DOI

EISSN

1528-1167

Publication Date

December 2020

Volume

61

Issue

12

Start / End Page

2774 / 2784

Location

United States

Related Subject Headings

  • Spasms, Infantile
  • Seizures
  • Risk Factors
  • Prospective Studies
  • Neurology & Neurosurgery
  • Neuroimaging
  • Male
  • Magnetic Resonance Imaging
  • Logistic Models
  • Infant, Newborn, Diseases
 

Citation

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Glass, H. C., Grinspan, Z. M., Li, Y., McNamara, N. A., Chang, T., Chu, C. J., … Neonatal Seizure Registry Study Group, . (2020). Risk for infantile spasms after acute symptomatic neonatal seizures. Epilepsia, 61(12), 2774–2784. https://doi.org/10.1111/epi.16749
Glass, Hannah C., Zachary M. Grinspan, Yi Li, Nancy A. McNamara, Taeun Chang, Catherine J. Chu, Shavonne L. Massey, et al. “Risk for infantile spasms after acute symptomatic neonatal seizures.Epilepsia 61, no. 12 (December 2020): 2774–84. https://doi.org/10.1111/epi.16749.
Glass HC, Grinspan ZM, Li Y, McNamara NA, Chang T, Chu CJ, et al. Risk for infantile spasms after acute symptomatic neonatal seizures. Epilepsia. 2020 Dec;61(12):2774–84.
Glass, Hannah C., et al. “Risk for infantile spasms after acute symptomatic neonatal seizures.Epilepsia, vol. 61, no. 12, Dec. 2020, pp. 2774–84. Pubmed, doi:10.1111/epi.16749.
Glass HC, Grinspan ZM, Li Y, McNamara NA, Chang T, Chu CJ, Massey SL, Abend NS, Lemmon ME, Thomas C, McCulloch CE, Shellhaas RA, Neonatal Seizure Registry Study Group. Risk for infantile spasms after acute symptomatic neonatal seizures. Epilepsia. 2020 Dec;61(12):2774–2784.
Journal cover image

Published In

Epilepsia

DOI

EISSN

1528-1167

Publication Date

December 2020

Volume

61

Issue

12

Start / End Page

2774 / 2784

Location

United States

Related Subject Headings

  • Spasms, Infantile
  • Seizures
  • Risk Factors
  • Prospective Studies
  • Neurology & Neurosurgery
  • Neuroimaging
  • Male
  • Magnetic Resonance Imaging
  • Logistic Models
  • Infant, Newborn, Diseases