Hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal brain injury, and these neonates may experience seizures soon after birth. The International League Against Epilepsy recommends discontinuation of ASMs at discharge if neonate is seizure-free for more than 72 hours. Hypoxic ischemic encephalopathy in neonates is more severe in our part of the world; it may not be practically possible to discontinue ASM after discharge. A six-year retrospective chart review of neonates with HIE who had seizures during hospital stays was done. They were followed for the recurrence of seizures until 12 months of age. A total of 190 term neonates were admitted with a diagnosis of HIE. Ninety had seizures in the hospital (moderate HIE n = 52 and severe HIE n = 38). Eighty-six percent (78/90) had clinical seizures, while 13.33% (12/90) had electro-clinical seizures. Seventy-two neonates survived to discharge. Nine neonates were discharged before 72 hours of seizure-free duration, and 22 were lost to follow before 3 months of age; hence, they were excluded from the study. A total of 41 neonates were followed for a median duration of 12 months (range: 3–12 months). Seizure recurrence after discharge occurred in 15 neonates (36.58%), with a median time of recurrence of six months ([4.00–7.00 IQR], [range 1–12 months]). Forty-six percent (7/15) had recurrence within 6 months (range 1–5 months), and out of which, 5 were severe HIE. Neonates who had recurrence were treated as epilepsy in their 12-month' follow-up (83.33% generalized epilepsy, 11.11% infantile spasms, 5.55% focal epilepsy).

Farhan Ali
Aga Khan University
Pakistan

Shahnaz Ibrahim
Aga Khan University
Pakistan