Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Early Hum Dev. 2012 Jan;88(1):33-8. doi: 10.1016/j.earlhumdev.2011.06.012. Epub 2011 Aug 10.
Neonatal seizures may persist despite treatment with multiple anti-epileptic drugs (AEDs).
To determine in term-born infants with seizures that required two or more AEDs, whether treatment efficacy and/or the underlying disorder were related to neurological outcome.
DESIGN/METHODS: We included 82 children (born 1998-2006) treated for neonatal seizures. We recorded mortality, aetiology of seizures, the number of AEDs required, achievement of seizure control, and amplitude-integrated-EEG (aEEG) background patterns. Follow-up consisted of an age-adequate neurological examination. Surviving children were classified as normal, having mild neurological abnormalities, or cerebral palsy (CP).
Forty-seven infants (57%) had status epilepticus. The number of AEDs was not related to neurological outcome. Treatment with three or four AEDs as opposed to two showed a trend towards an increased risk of a poor outcome, i.e., death or CP, odds ratio (OR) 2.74; 95% confidence interval (CI) 0.98-7.69; P=.055. Failure to achieve seizure control increased the risk of poor outcome, OR 6.77; 95%-CI 1.42-32.82, P=.016. Persistently severely abnormal aEEG background patterns also increased this risk, OR 3.19; 95%-CI 1.90-5.36; P<.001. In a multivariate model including abnormal aEEG background patterns, failure to achieve seizure control nearly reached significance towards an increased risk of poor outcome, OR 5.72, 95%-CI 0.99-32.97, P=.051. We found no association between seizure aetiology and outcome.
In term-born infants with seizures that required two or more AEDs outcome was poorer if seizure control failed. The number of AEDs required to reach seizure control and seizure aetiology had limited prognostic value.
新生儿癫痫发作即使经过多种抗癫痫药物（AED）治疗也可能持续存在。
在需要两种或更多种 AED 治疗的足月出生婴儿中，确定治疗效果和/或潜在疾病是否与神经结局相关。
设计/方法：我们纳入了 82 名（1998-2006 年出生）接受新生儿癫痫发作治疗的儿童。我们记录了死亡率、癫痫发作的病因、所需 AED 的数量、癫痫发作控制的实现情况以及振幅整合脑电图（aEEG）背景模式。随访包括年龄适当的神经系统检查。幸存的儿童被分为正常、轻度神经异常或脑瘫（CP）。
47 名婴儿（57%）有癫痫持续状态。AED 的数量与神经结局无关。与使用两种 AED 相比，使用三种或四种 AED 治疗的趋势表明不良结局（即死亡或 CP）的风险增加，即比值比（OR）2.74；95%置信区间（CI）0.98-7.69；P=.055。未能实现癫痫发作控制增加了不良结局的风险，OR 6.77；95%CI 1.42-32.82，P=.016。持续严重异常的 aEEG 背景模式也增加了这种风险，OR 3.19；95%CI 1.90-5.36；P<.001。在包括异常 aEEG 背景模式的多变量模型中，未能实现癫痫发作控制几乎达到了增加不良结局风险的显著性，OR 5.72；95%CI 0.99-32.97；P=.051。我们没有发现癫痫发作病因与结局之间的关联。
在需要两种或更多种 AED 治疗的足月出生婴儿中，如果未能控制癫痫发作，则结局较差。达到癫痫发作控制所需的 AED 数量和癫痫发作病因的预后价值有限。
