Saenchai Warisara, Manopunya Satit, Kosarat Shanika, Khuwuthyakorn Varangthip, Tantiprabha Watcharee, Katanyuwong Kamornwan, Sanguansermsri Chinnuwat, Wiwattanadittakul Natrujee
Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Brain Dev. 2025 Aug;47(4):104373. doi: 10.1016/j.braindev.2025.104373. Epub 2025 May 26.
To investigate the clinical profile, etiologies, and outcomes of neonatal seizures and identify predictors of drug-resistant epilepsy (DRE) in children.
A retrospective chart review was performed on neonates with seizures admitted to Chiang Mai University Hospital, Thailand, from January 2008 to December 2023. The diagnosis of neonatal seizures was based on clinical findings and/or electroencephalography. Severe impairment refers to limited mobility and minimal speech, while profound impairment indicates being bedridden. DRE is defined as the failure of two antiseizure medications to control seizures.
Among 218 patients (58.3 % male), the median seizure onset was 12 h (interquartile range [IQR]: 2.9-87 h). The leading etiology was perinatal asphyxia (58.7 %), followed by hemorrhage (7.8 %). The median follow-up was 27 months (IQR: 31.5 months). Epilepsy developed in 39 (27.3 %) patients, with 19 (48.7 %) meeting DRE criteria. Risk factors for epilepsy included marked abnormal neuroimaging, refractory neonatal seizures and severe to profound developmental impairment (P <0.05). In the multivariate model, profound developmental impairment (odds ratio [OR] = 2.89, p = 0.04, 95 % confidence interval [CI]: 1.79-24.19) and the development of epileptic spasms or multiple seizure types (OR = 114.80, p = 0.01, 95 % CI: 4.79-2746.07) were identified as an independent risk factor for DRE.
Perinatal asphyxia is the most common cause of neonatal seizures. One-third of neonates with seizures developed epilepsy, with half of them meeting the criteria for DRE. Neonates who develop epileptic spasms, exhibit multiple seizure types, or have profound developmental impairment are key DRE predictors.
研究新生儿惊厥的临床特征、病因及预后，并确定儿童耐药性癫痫（DRE）的预测因素。
对2008年1月至2023年12月在泰国清迈大学医院收治的惊厥新生儿进行回顾性病历审查。新生儿惊厥的诊断基于临床表现和/或脑电图。严重损伤是指活动受限和言语极少，而极重度损伤则指卧床不起。DRE定义为两种抗癫痫药物未能控制惊厥发作。
在218例患者中（58.3%为男性），惊厥发作的中位时间为12小时（四分位间距[IQR]：2.9 - 87小时）。主要病因是围产期窒息（58.7%），其次是出血（7.8%）。中位随访时间为27个月（IQR：31.5个月）。39例（27.3%）患者发生癫痫，其中19例（48.7%）符合DRE标准。癫痫的危险因素包括明显异常的神经影像学检查、难治性新生儿惊厥以及重度至极重度发育障碍（P<0.05）。在多变量模型中，极重度发育障碍（比值比[OR]=2.89，p = 0.04，95%置信区间[CI]：1.79 - 24.19）以及癫痫痉挛或多种惊厥类型的出现（OR = 114.80，p = 0.01，95% CI：4.79 - 2746.07）被确定为DRE的独立危险因素。
围产期窒息是新生儿惊厥最常见的原因。三分之一的惊厥新生儿发生癫痫，其中一半符合DRE标准。发生癫痫痉挛、表现出多种惊厥类型或有极重度发育障碍的新生儿是DRE的关键预测因素。
