Acute symptomatic neonatal seizures, brain injury, and long-term outcome: The role of neuroprotective strategies

ABSTRACT

Introduction

Neonatal seizures are frequent but underdiagnosed manifestations of acute brain dysfunction and an important contributor to unfavorable outcomes. Etiology and severity of brain injury are the single strongest outcome determinants.

Areas covered

The authors will discuss the prognostic role of acute symptomatic seizures versus brain injury and the main neuroprotective and neurorestorative strategies for full-term and preterm infants.

Expert opinion

Prolonged acute symptomatic seizures likely contribute to long-term outcomes by independently adding further brain injury to initial insults. Correct timing and dosing of therapeutic interventions, depending on etiology and gestational ages, need careful evaluation. Although promising strategies are under study, the only standard of care is whole-body therapeutic hypothermia in full-term newborns with hypoxic-ischemic encephalopathy.

KEYWORDS:

• Acute symptomatic
• antiseizure medications
• brain injury
• erythropoietin
• experimental models
• hypothermia
• neonatal seizures
• neuroprotection
• outcome
• status epilepticus

Article highlights

• Acute symptomatic neonatal seizures are associated with worsening long-term outcome.

• The main prognostic factors are the etiology and severity of underlying brain injury.

• Experimental and clinical data suggest and independent role of seizures in brain injury, especially if prolonged.

• Whole-body therapeutic hypothermia in full-term neonates with hypoxic-ischemic encephalopathy results in improved long-term outcome and reduced seizure burden.

• Additional neuroprotective and neurorestorative strategies have been proposed to prevent or reduce detrimental secondary changes, with mixed results.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.