The neurologic outcome of 40 infants with EEG documented seizures of diverse etiologies was examined retrospectively at the Division of Neurology, The Children’s Hospital of Philadelphia, PA. Neurologic follow-up of 27 survivors performed at a mean age of 31 months (range 5 to 56 months) was favorable in 30% of the study population. The remaining 70% (28 of 40) with an unfavorable outcome included mortality in 33% and severe morbidity in 38%. Epilepsy occurred in 56% of survivors (15 of 27), development delay - 67%, and cerebral palsy - 63%. Factors influencing the outcome were the etiology of the seizures, the age at the onset of seizures, birth weight and neurologic examination results. Asphyxia, meningitis and cerebral dysgenesis carried a poor prognosis. Onset of seizures within the first day of life and a severely abnormal neurologic exam significantly predicted an unfavorable outcome. An Apgar score less than 5 at 5 minutes was not significantly related to a poor prognosis. The EEG background activity was the only EEG parameter of value in prognosis: an abnormal background carried an unfavorable outcome in 81% and a normal background was predictive of a favorable prognosis in 67%. [1]
COMMENT. In this retrospective study of neonates with EEG proven seizures, the mortality rate was 33% and the morbidity rate was 56%.
The long-term outcome of an infant with pyridoxine-dependent neonatal seizures is reported from the British Columbia’s Children’s Hospital, Vancouver, BC, Canada [2]. Generalized clonic seizures began at 6 days of age followed by partial motor seizures becoming secondarily generalized at 1 month, and episodes of status epilepticus lasting 1 hour at 2-1/2 months. Seizures were controlled and the EEG normalized by 100 mg pyridoxine daily. The patient remained seizure free until age 20 months and then developed episodes of status epilepticus twice a week, always associated with infections. Monthly IV gamma globulin therapy 400 mg/kg infused over 6 hours resulted in prevention of infections and control of convulsions. IVIg therapy may be helpful in the treatment of pyridoxine-dependent seizures beginning in the neonatal period and may improve the long-term outcome.