Department of Neurology, University of California at San Francisco, San Francisco, California 94143, USA.
Pediatr Res. 2011 Nov;70(5):535-40. doi: 10.1203/PDR.0b013e31822f24c7.
We examined neonatal predictors of epilepsy in term newborns with neonatal encephalopathy (NE) by studying children enrolled in a longitudinal, single center cohort study. Clinical data were obtained through chart review, and MRI was performed in the neonatal period. We administered a seizure questionnaire to parents of children aged ≥ 12 mo (range, 12 mo to 16.5 y) to determine the outcome of epilepsy. The association between clinical predictors and time to onset of epilepsy was assessed using Cox proportional hazards regression. Thirteen of 129 children developed epilepsy: all had neonatal seizures and brain injury on neonatal MRI. Of the newborns with neonatal seizures, 25% (15.8/1000 person-years) developed epilepsy, with the highest hazard ratios (HRs) in the newborns with status epilepticus (HR, 35.8; 95% CI, 6.5-196.5). Children with severe or near-total brain injury were more likely to develop epilepsy compared with those with only mild or moderate injury (HR, 5.5; 95% CI, 1.8-16.8). In a multivariable analysis adjusting for degree of encephalopathy and severe/near-total brain injury, status epilepticus was independently associated with epilepsy. These data add to information regarding epilepsy pathogenesis and further aid clinicians to counsel parents regarding the likelihood that a newborn with NE will develop epilepsy.
我们通过研究参加纵向单中心队列研究的儿童，检查了足月新生儿伴有脑病（NE）的癫痫的新生儿预测因素。通过病历回顾获取临床数据，并在新生儿期进行 MRI 检查。我们对年龄≥12 个月（范围 12 个月至 16.5 岁）的儿童的父母进行了癫痫发作问卷调查，以确定癫痫的结局。使用 Cox 比例风险回归评估临床预测因素与癫痫发作时间之间的关联。在 129 名儿童中有 13 名患有癫痫：所有儿童均有新生儿癫痫发作和新生儿 MRI 脑损伤。在有新生儿癫痫发作的新生儿中，25%（15.8/1000 人年）发生癫痫，癫痫持续状态的新生儿的风险比（HR）最高（HR，35.8；95%CI，6.5-196.5）。与仅有轻度或中度损伤的儿童相比，严重或接近完全性脑损伤的儿童更有可能发生癫痫（HR，5.5；95%CI，1.8-16.8）。在调整脑病严重程度和严重/接近完全性脑损伤的多变量分析中，癫痫持续状态与癫痫独立相关。这些数据增加了有关癫痫发病机制的信息，并进一步帮助临床医生就患有 NE 的新生儿发生癫痫的可能性向父母提供咨询。
