Clinical and polysomnographic risk factors as early predictors for the development of postnatal epilepsy were determined in 158 infants presenting with two or more seizures, in a study at Hospital Sao Lucas, Porto Alegre, Brazil. Epilepsy rate after neonatal seizures was 22% within 12 months follow-up and 33.8% within 48 months. The types of epilepsy syndromes included: West syndrome in 12 infants; focal symptomatic epilepsy in 10; infantile epileptic encephalopathy in 3; other generalized symptomatic epilepsies in 5; and miscellaneous (13). Perinatal asphyxia, electrolyte imbalance, and bacterial meningitis were the most frequent etiologic factors in neonatal seizures. An abnormal neurologic examination, cerebral palsy, cognitive deficits, and abnormal polysomnographic recording were predictors of an unfavorable outcome and development of postnatal epilepsy. Prematurity, birth weight, and perinatal asphyxia were not significantly related to outcome, but the incidence of postnatal epilepsy was significantly correlated with neonatal bacterial meningitis. Neonates with seizures that required large initial doses and maintenance anticonvulsant drugs were at greater risk of postnatal epilepsy. [1]

COMMENT. In this selected population that included infants in intensive care, a higher incidence of epilepsy than that seen in population-based studies could be expected. Multiple risk factors for neonatal seizures, and especially bacterial meningitis, are associated with a higher probability of developing postnatal epilepsy. An abnormal neurologic examination and polysomnographic abnormalities are predictors of an unfavorable outcome.