Dados do Trabalho

Título

Incidence of subclinical epileptic seizures in neonates with moderate and severe Hypoxic-Ischemic Encephalopathy undergoing Therapeutic Hypothermia

Introdução

Perinatal hypoxic-ischemic insult is one of the main risk factors for neonatal seizures, that are frequently underdiagnosed due to electroclinical dissociation phenomena, which is intensified with the use of therapeutic hypothermia (TH), and may contribute to a higher incidence of epilepsy and neurological sequelae in childhood

Objetivo

To assess the incidence of epileptic seizures in neonates with moderate and severe hypoxic-ischemic encephalopathy (HIE) undergoing (TH) and classify in relation to the presence or absence of associated clinical manifestations, in addition to the timing of the events

Método

Retrospective observational study carried out in a neurological referral neonatal intensive care unit in São Paulo. Neonates with moderate and severe HIE were selected, undergoing TH between 2018 and 2022. Neonatal seizures were evaluated with amplitude-integrated electroencephalogram associated with crude electroencephalogram, video image (video aEEG/EEG) and experienced clinical staff throughout the TH and rewarming protocol. Modified Sarnat and Sarnat Scale was used for clinical assessment of patients' neurological impairment

Resultados

We reviewed 104 cases, 5 were excluded due to lack of data or by description of mild HIE. Of the 99 neonates evaluated, 75 (75,7%) were classified as having moderate HIE and 24 (24,2%) with severe HIE. Of those neonates with moderate HIE, 16 (21,3%) had seizures, being that only 1 (6,2%) had a clinical seizure and 15 (93,7%) had subclinical seizures in monitoring. In 50% of the cases (n=8) the seizures occurred in the first 24 hours of life. Among the 24 patients with severe HIE, 10 (41,6%) had seizures, and only 1 (10%) had a clinical seizure and 9 (90%) had subclinical seizures. In 80% of the cases (n=8) the seizure occurred in the first 24 hours of life

Conclusão

The reported incidence of subclinical seizures varies widely, but is estimated to be responsible for most neonatal seizures, especially in patients undergoing TH. Our study demonstrates that more than 90% of neonates who had epileptic seizures did not present an evident clinical manifestation of such involvement, demonstrating the need for continuous electrographic monitoring for the proper management of these patients. In addition, the importance of monitoring in the first 24 hours of life is noted, since most seizures in patients undergoing TH occur during this period

Palavras-chave

Epileptic seizures in neonates, Hypoxic-Ischemic Encephalopathy