Neonatal brain MRI and short-term outcomes after acute provoked seizures

Yi Li¹, Aaron Scheffler², Anthony James Barkovich³, Taeun Chang⁴, Catherine J Chu⁵, Shavonne L Massey⁶, Nicholas S Abend^{6

7}, Monica E Lemmon⁸, Cameron Thomas⁹, Adam Numis¹⁰, Linda S Franck¹¹, Elizabeth Rogers¹², Andrew Callen¹³, Charles E McCulloch², Renée A Shellhaas¹⁴, Hannah C Glass^{2

10

12}

Affiliations

¹ Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. yi.li@ucsf.edu.
² Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
³ Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
⁴ Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁵ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁷ Departments of Anesthesia & Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁸ Department of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
⁹ Department of Pediatrics, University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹⁰ Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA.
¹¹ Department of Family Health Care Nursing, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
¹³ Department of Radiology, University of Colorado Denver School of Medicine, Denver, CO, USA.
¹⁴ Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.

PMID: 37454174
PMCID: PMC10615741
DOI: 10.1038/s41372-023-01723-3

Multicenter Study

Neonatal brain MRI and short-term outcomes after acute provoked seizures

Yi Li et al. J Perinatol. 2023 Nov.

. 2023 Nov;43(11):1392-1397.

doi: 10.1038/s41372-023-01723-3. Epub 2023 Jul 15.

Authors

Affiliations

¹ Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. yi.li@ucsf.edu.
² Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
³ Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
⁴ Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
⁵ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁷ Departments of Anesthesia & Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁸ Department of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
⁹ Department of Pediatrics, University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹⁰ Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA.
¹¹ Department of Family Health Care Nursing, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
¹³ Department of Radiology, University of Colorado Denver School of Medicine, Denver, CO, USA.
¹⁴ Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.

PMID: 37454174
PMCID: PMC10615741
DOI: 10.1038/s41372-023-01723-3

Abstract

Objective: We investigated how diagnosis and injury location on neonatal brain MRI following onset of acute provoked seizures was associated with short term outcome.

Study design: A multicenter cohort of neonates with acute provoked seizures enrolled in the Neonatal Seizure Registry. MRIs were centrally evaluated by a neuroradiologist for location of injury and radiologic diagnosis. Clinical outcomes were determined by chart review. Multivariate logistic regression was used to examine the association between MRI findings and outcomes.

Results: Among 236 newborns with MRI at median age 4 days (IQR 3-8), 91% had abnormal MRI. Radiologic diagnoses of intracranial hemorrhage (OR 3.2 [1.6-6.5], p < 0.001) and hypoxic-ischemic encephalopathy (OR 2.7 [1.4-5.4], p < 0.003) were associated with high seizure burden. Radiologic signs of intracranial infection were associated with abnormal neurologic examination at discharge (OR 3.9 [1.3-11.6], p < 0.01).

Conclusion: Findings on initial MRI can help with expectant counseling on short-term outcomes following acute provoked neonatal seizures.

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Conflict of interest statement

RS is the only author with relevant disclosures, including: Associate Editor for Neurology; consultant for the Epilepsy Study Consortium; and receives royalties from UpToDate for authorship of topics related to neonatal seizures. The other authors have no relevant disclosures or conflicts of interest.

Figures

**Fig. 1. Inclusion and exclusion criteria for the study.**
After exclusion of 16 neonates with no MRI, the final cohort consisted of 236 neonates.

**Fig. 2. Examples of injury based on location.**
A Axial T2 weighted imaging demonstrating cortical injury in the setting of arterial ischemic stroke, with missing cortical ribbon (white arrow) in area of edematous, injured cortex. B Axial ADC map demonstrating reduced diffusion in the deep gray nuclei signifying acute injury (arrowheads).

**Fig. 3. Radiologic diagnoses in the cohort of patients with acute symptomatic seizures.**
A Axial ADC map demonstrating arterial ischemic stroke in the left middle cerebral artery territory (white arrow). B Axial ADC map demonstrating reduced diffusion in the deep gray nuclei and subcortical white matter, compatible with hypoxic ischemic injury. C Axial T2 weighted imaging demonstrating large subpial hemorrhage in the medial right frontal lobe (asterisk) with associated hemorrhagic injury of the right frontal lobe. D Axial T1-weighted post-contrast imaging demonstrating leptomeningeal enhancement (arrowheads) in the setting of neonatal meningitis/intracranial infection.

See this image and copyright information in PMC

References

1. Glass HC, Grinspan ZM, Shellhaas RA. Outcomes after acute symptomatic seizures in neonates. Semin Fetal Neonatal Med. 2018;23:218–22. doi: 10.1016/j.siny.2018.02.001. - DOI - PubMed
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1. Glass HC, Hong KJ, Rogers EE, Jeremy RJ, Bonifacio SL, Sullivan JE, et al. Risk factors for epilepsy in children with neonatal encephalopathy. Pediatr Res. 2011;70:535–40. doi: 10.1203/PDR.0b013e31822f24c7. - DOI - PMC - PubMed
1. McDonough TL, Paolicchi JM, Heier LA, Das N, Engel M, Perlman JM, et al. Prediction of future epilepsy in neonates with hypoxic-ischemic encephalopathy who received selective head cooling. J Child Neurol. 2017;32:630–7. doi: 10.1177/0883073817698628. - DOI - PubMed

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Neonatal brain MRI and short-term outcomes after acute provoked seizures

Affiliations

Neonatal brain MRI and short-term outcomes after acute provoked seizures

Authors

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Abstract

Conflict of interest statement

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