Do neonatal seizures cause brain injury?

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In pediatrics, seizures are most frequent in infants and the most frequent association (cause) is hypoxic-ischemia associated with birth. The question asked by Glass et al is whether these seizures injure the brain beyond that caused by the hypoxic-ischemia. They assessed the amount of brain injury detected by MRI and then correlated neurologic outcomes for asphyxiated term infants with seizures. Their conclusion is that seizures probably increase the injury and compromise neurodevelopmental outcomes. Although this conclusion is consistent with animal models, the “probably” as a qualifier results from the complexity of the clinical material and the use of medications to treat seizures, as discussed in an editorial by Silverstein. The medications used to treat seizures in newborns can impair brain development in animal models. Further, the identification of clinical seizures is quite imprecise, and the description of the seizure activity by continuous EEG monitoring is complex. The use of hypothermia to treat asphyxiated infants with or without seizures will further complicate outcome analyses. However, this report is an important contribution that should stimulate further research into the recognition and appropriate treatment of neonatal seizures; the pay-off may be better outcomes.

Article page 318▸

Editorial page 305▸