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Clinical, electrophysiological, and neuroimaging predictors for antiseizure medication in infants with neonatal clinical seizures

Objective. We aimed to determine the clinical, electroencephalography (EEG) and magnetic resonance imaging (MRI) predictors in infants with neonatal seizures for the antiseizure medication (ASM). Methods: In this retrospective study, 652 infants with neonatal clinical seizures followed between 2005 and 2021 were included. From the patients’ charts, the clinical parameters (demographics, etiology, and seizure semiology in neonatal period), electroencephalography characteristics, and magnetic resonance imaging findings were recorded. Subjects were divided into two groups with ASM follow-up period at 2 years of age; group I (infants with seizure-free) and group I (infants with ASM). Univariate and multivariate analyses were performed for the predictive value of the clinical-demographic variable, EEG characteristics, and MRI findings. Results: Group I consisted of 399 (61.2 %) infants with seizure-free (ASM duration: Mean±SD: 4.4±3.3 months). Grup II included 253 (38.8%) infants with ASM therapy (Mean±SD: 18.5±6.3 months). Univariate analysis revealed that certain clinical parameters (birth weight, seizure semiology, duration of ASM, polytherapy), EEG characteristics, and MRI findings are valuable clinical predictors for ASM continuation in infants with neonatal seizures (Table 1). However multivariate analysis with the Cox regression model predicted the following parameter significantly associated with the continuation of ASM treatment in infants with neonatal seizures: HIE, brain malformation, EEG characteristics, and MRI findings. Conclusions: This cohort study revealed that the presence of HIE, structural abnormalities, abnormal EEG on the first month-age, and MRI abnormalities between 4-8 months of age were valuable predictors for long-term ASM treatment in infants with neonatal seizures.
Keywords: Neonatal, seizure, antiseizure medication,electroencephalography,magnetic resonance imaging