Brain cooling reduces the risk of post-neonatal epilepsy in newborns affected by moderate to severe hypoxic-ischemic encephalopathy.

BACKGROUND: Neonatal hypoxic-ischemic encephalopathy is still a significant cause of neonatal death and neurodevelopmental disabilities, such as cerebral palsy, mental delay, and epilepsy. After the introduction of therapeutic hypothermia, the prognosis of hypoxic-ischemic encephalopathy has improved, with reduction of death and disabilities. However, few studies evaluated whether hypothermia affects rate and severity of post-neonatal epilepsy. We evaluated rates, characteristics and prognostic markers of post-neonatal epilepsy in infants with moderate to severe hypoxic-ischemic encephalopathy treated or not with therapeutic hypothermia.

METHODS: We analyzed clinical data, EEG recordings, cerebral Magnetic Resonance Imaging (MRI) and outcome in 23 cooled and 26 non-cooled asphyxiated neonates (≥36 weeks' gestation), admitted from 2004 to 2012.

RESULTS: Among 49 neonates 11 (22%) had post-neonatal epilepsy, of which 9 (18%) were non-cooled and 2 (4%) were cooled (p=0.05). Six of 11 infants (55%) had West syndrome, 4 (36%) had focal epilepsy and 1 (9%) had Lennox- Gastaut syndrome. At multiple logistic regression analysis MRI pattern significantly correlated with post-neonatal epilepsy (OR 0.19, 95% CI 0.04-0.88, p=0.03). Extensive lesions in basal ganglia and thalami plus cortical and white matter were associated with post-neonatal epilepsy.

CONCLUSIONS: Only perinatal asphyxia with extensive lesions in basal ganglia and thalami plus cortical and white matter lesion conveys an high risk for early and severe post-neonatal epilepsy. Moreover therapeutic hypothermia is associated with a decrease of the risk of developing post-neonatal epilepsy.