Last modified: 2018-09-09
Abstract
Purpose - To study the epilepsy following neonatal hypoglycemic brain injury (NHBI).
Methods - Retrospectively review of epilepsy in 30 children following neonatal hypoglycemia confirmed by history of blood sugars <40g/dl in first week (13) and/or seizure D1-5 of life (28) and/or parieto-occipital gliosis on MRI (22).
Results: Mean age at follow-up was 10.7 years and mean follow-up duration was 6 years. Onset of epilepsy was in infancy (16) or by 5 years (12). Focal motor versive seizures were commonest (16). 3 children achieved remission with monotherapy, 23 with polytherapy, 4 remained refractory. Valparin and Levetiracetam were most commonly used AEDs.
All those who achieved remission had a relapsing remitting course with maximum remission period of 2.4 years. Mean duration of seizure activity (duration between 1st and last seizure) was 7 years. 28 had seizures in last 5 years of follow up (active epilepsy), 2 achieved terminal remission for 5 years. All children were on antiepileptics at last point of contact and none had resolved.
18 children had multiple comorbidities (ID-13, CVI-10, ADHD-8, ASD-4, speech delay-3, LD-2, CP- 4, Apraxia of hand use-2), 9 had single and 3 had none. ID, ADHD and CVI were commonest.
Conclusion: Children with epilepsy following NHBI do achieve an average remission of 2 years with polytherapy, but develop a relapsing remitting course, needing long term AEDs and rarely achieve complete resolution. Developmental comorbidities are a rule. Early, aggressive and regular treatment of epilepsy and the comorbidities can improve the outcome.