Risk Factors For Seizures Research Articles

Iron-Deficiency Anemia as a Risk Factor for the First Simple Febrile Convulsion

Background: Febrile seizure is the most common convulsive disorder in childhood. The role of iron in the metabolism of neurotransmitters and carrying oxygen to the brain suggests the possibility of a relationship between iron-deficiency anemia and febrile seizures. Objectives: The aim of study is to study the role of iron-deficiency anemia as a risk factor for febrile seizures. Materials and Methods: This is a hospital-based case–control study performed in 30 children with febrile seizures (case) and 80 febrile children without seizures (control) who were aged between 6 and 60 months. The groups were matched in terms of age, gender, and the use of supplemental iron. Laboratory tests consisted of complete blood count, serum iron, plasma ferritin were done for each patient. Results: Thirty-four percent of the cases with febrile seizure had iron-deficiency anemia compared with 20% of children with febrile illness without seizure and 12% of healthy children. The odds ratio for iron-deficiency anemia in the patients with febrile seizure was 3.059 (95% confidence interval (CI) = 0.969–9.657) compared with the febrile children without convulsion and 5.608 (95% CI = 1.834–17.146) compared with the healthy group. Conclusion: Based on the result of this study, iron deficiency could be an important risk factor for the development of febrile convulsion. This encourages the evaluation of iron status in children with febrile seizure.

De novo epilepsy after microsurgical resection of brain arteriovenous malformations.

Seizures are the second most common presenting symptom of brain arteriovenous malformations (bAVMs) after hemorrhage. Risk factors for preoperative seizures and subsequent seizure control outcomes have been well studied. There is a paucity of literature on postoperative, de novo seizures in initially seizure-naïve patients who undergo resection. Whereas this entity has been documented after craniotomy for a wide variety of neurosurgically treated pathologies including tumors, trauma, and aneurysms, de novo seizures after bAVM resection are poorly studied. Given the debilitating nature of epilepsy, the purpose of this study was to elucidate the incidence and risk factors associated with de novo epilepsy after bAVM resection. A retrospective review of patients who underwent resection of a bAVM over a 15-year period was performed. Patients who did not present with seizure were included, and the primary outcome was de novo epilepsy (i.e., a seizure disorder that only manifested after surgery). Demographic, clinical, and radiographic characteristics were compared between patients with and without postoperative epilepsy. Subgroup analysis was conducted on the ruptured bAVMs. From a cohort of 198 patients who underwent resection of a bAVM during the study period, 111 supratentorial ruptured and unruptured bAVMs that did not present with seizure were included. Twenty-one patients (19%) developed de novo epilepsy. One-year cumulative rates of developing de novo epilepsy were 9% for the overall cohort and 8.5% for the cohort with ruptured bAVMs. There were no significant differences between the epilepsy and no-epilepsy groups overall; however, the de novo epilepsy group was younger in the cohort with ruptured bAVMs (28.7 ± 11.7 vs 35.1 ± 19.9 years; p = 0.04). The mean time between resection and first seizure was 26.0 ± 40.4 months, with the longest time being 14 years. Subgroup analysis of the ruptured and endovascular embolization cohorts did not reveal any significant differences. Of the patients who developed poorly controlled epilepsy (defined as Engel class III-IV), all had a history of hemorrhage and half had bAVMs located in the temporal lobe. De novo epilepsy after bAVM resection occurs at an annual cumulative risk of 9%, with potentially long-term onset. Younger age may be a risk factor in patients who present with rupture. The development of poorly controlled epilepsy may be associated with temporal lobe location and a delay between hemorrhage and resection.

Risk factors for preoperative seizures in meningiomas - base versus non-bases of supratentorial

Background: Meningiomas are the most frequent benign intracranial lesions. The literature review reported that 19-63% of the patients with meningioma suffer from preoperative seizures, and 35% experience epileptic seizures as the initial symptom. The present study attempted to establish the risk factors for seizures before surgery of supratentorial meningiomas. Objective: To compare predictive factors for preoperative seizures for skull base meningiomas (SBMs), with non-skull base meningiomas (NSBMs). Materials and methods: The clinical data of 244 patients with supratentorial meningiomas treated microsurgically between 2007 and 2018 were analyzed retrospectively. There were two groups; Group “A” with (NSBMs) and Group “B” with (SBMs). Demographic, clinical, imaging, histopathological, and electroencephalographic data were assessed. Univariate statistical analyses were performed among factors that might correlate with preoperative seizures. Results: A total of 244 patients with a diagnosis of intracranial meningioma were retrospectively evaluated. The mean age was 54.34 years (range 16- 84), females 165, meals 79. Of these 154 patients for the non-skull base, seizures in 65 (42.2%), whereas, 90 patients for skull base, with 32 (35.5%) patients with seizures. The groups had similar preoperative seizure occurrence in relation to age (p=0.154, p=0.819), gender (p=0.396, p=0.445) tumor size (p=0.318,p=0.244), tumor side(p0.836, p=0.702) for Group A and B respectively. The pre-op seizure was the third presentation in both groups after non-focal symptoms and (FND) respectively. For Group “A” seizure as the initial symptom was in 49.2% of patients versus 50.8% for others, while in Group “B” was in 37.5% vs 62.5%. The both groups had statistically significance between PTBE and pre op seizure, for Group “A”,PTBE was in 93(60.4%) patients,(seizure in 51patients 78.5%) vs (42 patients 47.2% for non-seizure), (?2=,15.356, p=0.000). For Group “B”, PTBE was in 43(47.8%) patients,(seizure in 25 patients 78.1%) vs(18 patients 31% for non-seizure),(?2=,18.328, p=0.000). The most frequently seizure for Group “B” was in OGM (seizure 25% vs 13.8 without seizure) and SWM (seizure 71.8% vs 65.5% non-seizure), while lesser overall in planum/tuberculum (seizure3.2% vs 20.7% non-seizure). There was a statistically significant relationship between tumour location and preoperative seizure for (SBM), (?2=5.985, p=0.050) while absent in Group “A”. (?2=1.373, p=0.503). There were no differences between the two groups with WHO grade and pre-op seizure. The unexpected finding in this study is that the presence of preoperative neurologic deficits has been less frequently associated with preoperative seizures in both groups. Careful analysis and further investigation are needed. Conclusion: We identified that the major risk factor for pre-op seizure in both group studies is PTBE, and location for skull base meningiomas, where the planum/tuberculum lesser overall risk for pre-op seizure. While other radiological and histopathological factors are statistically non-significant. Interestingly, the factors associated with preoperative seizures were the absence of preoperative neurologic deficits for both groups.

Frequency and Risk Factors of Seizures in Children During Induction Remission Chemotherapy for Acute Lymphoblastic Leukemia (ALL)

Background: Seizure is one of the most common CNS complications among patients receiving chemotherapy for acute lymphoblastic leukemia (ALL). Seizures are seen in 8-13% of patients with ALL. Most seizure occurs during the induction and consolidation phases of treatment. However, not much is known about the risk factors of these seizure.
 Materials & Method: This prospective observational study was conducted in the department of Pediatric Hematology and Oncology, BSMMU. One hundred and five newly diagnosed admitted children with ALL aged >1 year to <18 years, from May 2017 to March 2018 for induction remission chemotherapy and who fulfilled the criteria of case definition were enrolled into this study.
 Results: This study showed that seizure frequency was14.3% in children with ALL getting induction remission chemotherapy. Female patients developed seizures more than males which was statistically significant by univariate analysis (p = 0.029) but was not found to be a risk factor by multivariate analysis (p = 0.059). All the seizures developed in B-lineage ALL but there was no statistically significant association between lineage of ALL with development of seizures.
 Conclusions: In this study slightly higher frequency of seizure in ALL patients on induction remission chemotherapy was found than previous studies (14.3% vs. 13%). Females developed seizures more than males.
 BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 94-98

Risk of seizures in a population of women with BRCA-positive metastatic breast cancer in the United States.

e13056 Background: Real-world evidence on the risk of seizures in subgroups of women with advanced breast cancer (BC) across treatment-related or clinical subtypes is limited. A large electronic health record (EHR) dataset was used in this study to measure incidence and risk factors for seizures among women diagnosed with BRCA-associated metastatic BC (mBC). Methods: We used the Optum EHR database, which includes natural language processing (NLP) abstracted details from physicians’ notes, to identify a cohort of females with mBC (based on secondary malignancy ICD-9/-10 codes or NLP) diagnosed between 2008-2018 with 12 months of pre-index history, evidence of BRCA mutation positive (BRCA+) status, and no history of prior cancers. Analyses were stratified by the overall BRCA+ cohort and 4 molecular phenotypes: HER2+/HR-, HER2-/HR+, HER2+/HR+, and triple negative BC (TNBC). Incidence of seizures was measured using diagnosis codes and NLP, and incidence rates were calculated as the number of women with a seizure over the period from metastasis to first seizure or the end of follow up. Incidence rates were also measured across the following risk factors: PARP inhibitor use, diagnosed brain metastases, history of seizures, and anticonvulsant use before BC diagnosis, while controlling for age at metastasis, number of prior lines, and metastasis location. Results: Of the 7,941 BRCA+ patients identified, 27.8% had ≥1 seizure during mean follow-up of 2.35 years, with an incidence rate of 11.83 (95% CI: 11.35-12.33) per 100 person-years. The HER2-/HR+ and TNBC subgroups had the lowest and highest seizure incidence rates, respectively (10.94 [95% CI: 10.23-11.71] and 16.83 [95% CI: 15.34-18.46]). Kaplan-Meier analysis of time to seizure showed that HR- phenotype was associated with a longer time to first seizure. Patients with diagnosed brain metastases or a history of seizures had higher seizure incidence rates compared to patients without the respective risk factors (42.55 [95% CI: 28.59-63.30] vs 5.26 [4.20-6.59] and 34.76 [23.24-52.01] vs 6.35 [5.11-7.88]). Incidence trended higher with PARP inhibitor use, but patient numbers were low. Conclusions: Using both diagnosis codes and NLP, this study shows that seizures occur frequently in women with BRCA+ mBC, even those without diagnosed brain metastases. The seizure incidence rates by phenotype underscore their relevance when assessing seizure risk. These findings may have implications for clinical practice and for assessing benefit-risk ratios of novel agents.[Table: see text]

P.030 Association between multiple sclerosis and seizures: a systematic review and meta-analysis

Background: Although seizures are a well-recognized phenomena in patients with multiple sclerosis (MS) with many observational studies reporting its prevalence and incidence, the relative risk of seizures or epilepsy in adults with MS compared to those without is not well-described. Methods: We systematically searched MEDLINE and Embase, from their inception to January 1, 2022, using keywords and database-specific terms. We included observational studies that reported risk of seizures or epilepsy in adults with MS and that in a comparison group, consisting of people without MS or the general population. We used a random-effects meta-analysis to report a pooled adjusted risk ratio (RR) of seizures in adults with MS compared to the comparison group. Results: We screened 8,750 articles and included 17 studies, totaling over 192,850 adults with MS of which 6064 (3.1%) had seizures. Compared to a comparison group, the pooled adjusted RR of seizures in adults with MS was 2.86 (95% CI, 2.35-3.47, I2 = 95.8%). Conclusions: MS should be considered an independent risk factor for seizures or epilepsy. Further research should help identify patients with MS who are at risk of seizures, to improve screening and treatment and in turn reduce the burden of epilepsy in this population.

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis.

Background: Tranexamic acid (TXA) has been applied in various types of surgery for hemostasis purposes. The efficacy and safety of TXA are still controversial in different surgeries. Guidelines for clinical application of TXA are needed. Materials and method: We systematically searched multiple medical databases for meta-analyses examining the efficacy and safety of TXA. Types of surgery included joint replacement surgery, other orthopedic surgeries, cardiac surgery, cerebral surgery, etc. Outcomes were blood loss, blood transfusion, adverse events, re-operation rate, operative time and length of hospital stay, hemoglobin (Hb) level, and coagulation function. Assessing the methodological quality of systematic reviews 2 (AMSTAR 2) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) were used for quality assessment of the included meta-analyses. Overlapping reviews were evaluated by calculating the corrected covered area (CCA). Result: In all, we identified 47 meta-analyses, of which 44 of them were of “high” quality. A total of 319 outcomes were evaluated, in which 58 outcomes were assessed as “high” quality. TXA demonstrates significant hemostatic effects in various surgeries, with lower rates of blood transfusion and re-operation, shorter operative time and length of stay, and higher Hb levels. Besides, TXA does not increase the risk of death and vascular adverse events, but it is a risk factor for seizure (a neurological event) in cardiac surgery. Conclusion: Our study demonstrates that TXA has a general hemostatic effect with very few adverse events, which indicates TXA is the recommended medication to prevent excessive bleeding and reduce the blood transfusion rate. We also recommend different dosages of TXA for different types of adult surgery. However, we could not recommend a unified dosage for different surgeries due to the heterogeneity of the experimental design. Systematic Review Registration: clinicaltrials.gov/, identifier CRD42021240303

Seizure control during the COVID-19 pandemic: Correlating Responsive Neurostimulation System data with patient reports

ObjectiveTo understand the impact of the Coronavirus Disease-2019 (COVID-19) pandemic on seizure frequency in persons with epilepsy with a Responsive Neurostimulation (RNS) system implanted. MethodsWeekly long episode counts (LEC) were used as a proxy for seizures for six months pre-COVID-19 and during the COVID-19 period. Telephone surveys and chart reviews were conducted to assess patient mental health during the pandemic. The change in LEC between the two time periods was correlated to reported stressors. ResultsTwenty patients were included. Comparing the pre-COVID-19 period to the COVID-19 period, we found that only 5 (25%) patients had increased seizures, which was positively correlated with change in anti-seizure medications (ASM, p = 0.03) and bitemporal seizures (p = 0.03). Increased seizures were not correlated to anxiety (p = 1.00), depression (p = 0.58), and sleep disturbances (p = 1.00). The correlation between RNS-detected and patient-reported seizures was poor (p = 0.32). ConclusionsMost of our patients did not have an increase in seizures following the COVID-19 pandemic. Changes in ASM and bitemporal seizures were positively correlated to increased LEC. There was no correlation between pandemic-related stress and seizures in those found to have increased seizures. SignificanceThis is the first study correlating RNS-derived objective LECs with patient self-reports and potential seizure risk factors during the COVID-19 pandemic.

Association of Serum Calcium and Magnesium Level with Febrile Seizure

Background: Febrile seizures occur in 2 to 5% of all children with a recurrence rate of 30 to 40%. Calcium and magnesium is closely related to pathophysiology of seizures and aim of this study was to find out the association of serum calcium and magnesium level with febrile seizure.
 Methods: A cross sectional analytical study was conducted among One hundred (100) subjects of both sexes with age range 6 months to 60 months in department of pediatrics from June 2019 to May 2020. The subjects were grouped into case (group A) and control (group B) by purposive sampling who were seeking fever with convulsion (group A) and fever without convulsion (group B). Statistical analyses were performed by Chi-square test and/or Fisher’s exact test as applicable for comparing qualitative variables and for quantitative variables using unpaired t-test and/or Mann-Whitney U test for comparing between the groups. Pearson’s Correlation Coefficient test was done to observe the correlation between low calcium and Magnesium level in febrile seizure. A p-value of <0.05 was considered as significant for all analytical tests.
 Results: Hypocalcaemia were more in 25-36 months of age and hypomagnesaemia 37-48 months in febrile seizure Hypomagnesaemia were more in patients who had previous febrile seizure (1.89 ± 0.73 mg/dl, p- value 0.045). Association and positive correlation were found between serum calcium and serum magnesium with febrile seizure. Multivariate logistic regression showed hypocalcaemia and hypomagnesaemia are independent risk factor for febrile seizures where hypocalcaemia OR=2.144 and hypomagnesaemia OR 1.2.
 Conclusion: Association and positive correlation were found between serum calcium and serum magnesium with febrile seizure and more in recurrent febrile seizure.
 Sir Salimullah Med Coll J 2022; 30: 14-22

Independent risk factors for seizures in critically ill patients on continuous EEG.

The objective of this study was to characterize the independent risk factors for seizures in critically ill patients monitored with continuous EEG (cEEG). We retrospectively investigated variables associated with cEEG seizures, first in the entire cohort of 156 patients and, subsequently, in the subgroup without seizures in the first 30 minutes of monitoring. Seizures were observed in 19.2% of recordings, and in 50% of these, seizures occurred in the first 30 minutes. In the entire cohort, epilepsy, acute seizures prior to cEEG, interictal epileptiform discharges (IEDs), lateralized periodic discharges (LPDs), and brief potentially ictal rhythmic discharges (BIRDs) were associated with a higher incidence of cEEG seizures, whereas coma, intravenous anaesthetic drugs, and generalized periodic discharges (GPDs) were associated with a lower incidence of seizures. On multivariate analysis, this association was maintained for acute seizures before cEEG (OR: 5.92) and IEDs (OR: 6.81). Excluding patients with seizures at the beginning of monitoring, acute seizures before cEEG, IEDs, LPDs, and BIRDs were associated with an increased risk of seizures. The presence of IEDs or LPDs in the first 30 minutes was associated with a 4.14-fold greater chance of seizures on cEEG. On multivariate analysis, acute seizures prior to recording (OR 7.29) and LPDs (OR: 5.38) remained associated with seizures on cEEG. Due to the sample size, BIRDs were not included in multivariate models. Acute seizures prior to monitoring, IEDs, LPDs and BIRDs are important risk factors for cEEG seizures in critically ill patients.

Who is at Risk for Seizures After Heart Transplantation?

<h3>Purpose</h3> Seizures may occur following heart transplantation (HTx), especially since tacrolimus can lower a seizure threshold. HTx recipients are also at high stroke risk given many patients have existing cerebrovascular disease. The purpose of the study was to assess the prevalence and risk factors for seizures in HTx recipients at our center. <h3>Methods</h3> We assessed 560 patients who underwent HTx between 2015-2020 for the development of seizures within the first month post HTx. We assessed impact of putative risk factors on early post transplant seizures, including prior stroke, atherosclerotic vascular disease, prior seizures, diabetes, prior smoking, and male sex. <h3>Results</h3> 40 of 560 HTx patients (7.3%) developed seizures in the first post-transplant month. The seizure group was compared to the control group (n=520) for risk factors for seizures (see table). Univariate analysis found that hypertension, history of atherosclerosis, and history of previous seizures were significant risk factors to develop seizures in the first postoperative month. Multivariate analysis found that only hypertension and history of previous seizures were significantly associated with early seizures post-HTx. All patients with seizures were placed on anti-seizure medications and had tacrolimus switched to cyclosporine. <h3>Conclusion</h3> Seizures in the first post-transplant month occur in a significant minority of patients. Patients undergoing heart transplant with both history of hypertension and seizures are at risk to develop seizures in the early postoperative period. These patients might be considered for prophylactic anti-seizure therapy in the first 30 days following HTx surgery.

Post-stroke seizure risk prediction models: a systematic review and meta-analysis.

Stroke is the commonest cause of epileptic seizures in older adults. Risk factors for post-stroke seizure (PSS) are well known, however, predicting PSS risk is clinically challenging. This study aimed to evaluate the predictive accuracy of PSS risk prediction models developed to date. We performed a systematic review and meta-analysis of studies using MEDLINE and EMBASE from database inception to 28th December 2020. The search criteria included all peer-reviewed research articles, in which PSS risk prediction models were developed or validated for ischaemic and/or haemorrhagic stroke. Random-effects meta-analysis was used to generate summary statistics of model performance and receiver operating characteristic curves. Quality appraisal of studies was conducted using PROBAST. Thirteen original studies involving 182,673 stroke patients (mean age: 38-74.9 years; 29.4-60.9% males), reporting 15 PSS risk prediction models were included. The incidence of early PSS (occurring ≤one week from stroke onset) and late PSS (occurring >one week from stroke onset) was 4.5% and 2.1%, respectively. Cortical involvement, functional deficits, increasing lesion size, early seizures, younger age, and haemorrhage were the commonest predictors across the models. SeLECT demonstrated greatest predictive accuracy (AUC 0.77 [95%CI: 0.71-0.82]) for late PSS following ischaemic stroke, and CAVE for predicting late PSS following haemorrhagic stroke (AUC 0.81 [0.76-0.86]). Fourteen of 15 studies demonstrated a high risk of bias, with lack of model validation and reporting of performance measures on calibration and discrimination being the commonest reasons. Although risk factors for PSS are widely documented, this review identified few multivariate models with low risk of bias, synthetising single variables into an individual prediction of seizure risk. Such models may help personalise clinical management and serve as useful research tools by identifying stroke patients at high risk of developing PSS for recruitment into studies of anti-epileptic drug prophylaxis.

Predicting Early Seizures After Intracerebral Hemorrhage with Machine Learning.

Seizures are a harmful complication of acute intracerebral hemorrhage (ICH)."Early" seizures in the first week after ICH are a risk factor for deterioration, later seizures, and herniation. Ideally, seizure medications after ICH would only be administered to patients with a high likelihood to have seizures.We developed and validated machine learning (ML) models to predict early seizures after ICH. We used two large datasets to train and then validate our models in an entirely independent test set. The first model ("CAV") predicted early seizures from a subset of variables of the CAVE score (a prediction rule for later seizures)-cortical hematoma location, age less than 65years, and hematoma volume greater than 10mL-whereas early seizure was the dependent variable. We attempted to improve on the "CAV" model by adding anticoagulant use, antiplatelet use, Glasgow Coma Scale, international normalized ratio, and systolic blood pressure ("CAV + "). For each model we used logistic regression, lasso regression, support vector machines, boosted trees (Xgboost), and random forest models. Final model performance was reported as the area under the receiver operating characteristic curve (AUC) using receiver operating characteristic models for the test data. The setting of the study was two large academic institutions: institution 1, 634 patients; institution 2, 230 patients. There were no interventions. Early seizures were predicted across the ML models by the CAV score in test data, (AUC 0.72, 95% confidence interval 0.62-0.82). The ML model that predicted early seizure better in the test data was Xgboost (AUC 0.79, 95% confidence interval 0.71-0.87, p = 0.04) compared with the CAV model AUC. Early seizures after ICH are predictable. Models using cortical hematoma location, age less than 65years, and hematoma volume greater than 10mL had a good accuracy rate, and performance improved with more independent variables. Additional methods to predict seizures could improve patient selection for monitoring and prophylactic seizure medications.

Electroencephalography at the height of a pandemic: EEG findings in patients with COVID-19

ObjectiveTo characterize continuous video electroencephalogram (VEEG) findings of hospitalized COVID-19 patients. MethodsWe performed a retrospective chart review of patients admitted at three New York City hospitals who underwent VEEG at the peak of the COVID-19 pandemic. Demographics, comorbidities, neuroimaging, VEEG indications and findings, treatment, and outcomes were collected. ResultsOf 93 patients monitored, 77% had severe COVID-19 and 40% died. Acute ischemic or hemorrhagic stroke was present in 26% and 15%, respectively. Most common VEEG indications were encephalopathy/coma (60%) and seizure-like movements (38%). Most common VEEG findings were generalized slowing (97%), generalized attenuation (31%), generalized periodic discharges (17%) and generalized sharp waves (15%). Epileptiform abnormalities were present in 43% and seizures in 8% of patients, all of whom had seizure risk factors. Factors associated with an epileptiform VEEG included increasing age (OR 1.07, p = 0.001) and hepatic/renal failure (OR 2.99, p = 0.03). ConclusionsMost COVID-19 patients who underwent VEEG monitoring had severe COVID-19 and over one-third had acute cerebral injury (e.g., stroke, anoxia). Seizures were uncommon. VEEG findings were nonspecific. SignificanceVEEG findings in this cohort of hospitalized COVID-19 patients were those often seen in critical illness. Seizures were uncommon and occurred in the setting of common seizure risk factors.

Antenatal factors for neonatal seizures among late preterm births**

Objective The objective of this study was to evaluate for antenatal risk factors for neonatal seizures among late preterm births. Study design This was a case control study which included late preterm births without anomaly from the United States Natality database. Cases were infants with neonatal seizures, while the controls consisted of infants without neonatal seizures. Maternal and pregnancy characteristics were compared. Multivariable logistic regression was performed to investigate risk factors for neonatal seizures. Results Of the 943,580 late preterm births, 512 (0.05%) developed neonatal seizures. Significant risk factors associated with neonatal seizures among late preterm births included number of prenatal visits (adjusted odds ratio [aOR] 0.94, 95% CI [0.92–0.96]), smoking history (aOR 1.78, 95% CI [1.41–2.25]), chorioamnionitis (aOR 4.37, 95% CI [2.65–7.21]), non-Hispanic White race (aOR 1.41, 95% CI [1.13–1.76]), and cesarean birth (aOR 2.31, 95% CI [1.91–2.80]). Conclusion Number of prenatal visits, history of smoking, chorioamnionitis, non-Hispanic white race, and cesarean birth are risk factors for neonatal seizures at late preterm gestation.

Risk Factors for Clinical Seizures in Neonates with Hypoxic-ischemic Encephalopathy Treated with Therapeutic Hypothermia.

This study aimed to assess the risk factors for clinical seizures in newborns treated with whole body cooling (WBC) for hypoxic ischemic encephalopathy (HIE). Infants with gestational age≥36 weeks and birth weight≥2.000 g who were treated with WBC due to HIE were retrospectively enrolled in this study. Patients were assigned to two groups: infants without clinical seizures (Group 1) and infants with clinical seizures (Group 2). The two groups were compared to determine the risk factors for the occurrence of clinical seizures. A total of 25 patients (Group 1=10 and Group 2=15) were included in the study. Prothrombin time (PT) was determined as independent risk factor for clinical seizures (p=0.046) and the odds ratio for the effect of PT was found as 1.475 (%95 CI:1.006-2.299). PT (area under the curve [AUC]=0.764; p=0.041), and increased cardiac troponin-I (cTnI) (AUC=0.935; p=0.002) were found to be significant risk factors for predicting the occurrence of clinical seizures. The optimal PT cut-off value was 22.7 sec, with a sensitivity and specificity of 45.4% and 90%, respectively; as well as positive and negative predictive value of 83.3% and 60.0%, respectively. The chest compression in the delivery room, severely abnormal amplitude integrated electroencephalography and high encephalopathy score were also found risk factors for occurrence of clinical seizures. Chest compression in the delivery room, high encephalopathy score, prolonged PT, and increased cTnI are significant factors for clinical seizures in newborns treated with WBC for HIE.

Risk factors for seizures in the vigorous term neonate: A population-based register study of singleton births in Sweden.

BackgroundNeonatal seizures have been associated with increased mortality and impaired neurodevelopment and, knowledge about risk factors may be useful for prevention. Clear associations have been established between labor-related risk factors and seizures in asphyxiated neonates. However, there is limited information about why some vigorous term-born infants experience seizures.ObjectivesOur aim was to assess antepartum and intrapartum risk factors for seizures in vigorous term-born neonates.MethodsThis was a national cohort study of singleton infants born at term in Sweden from 2009–2015. Vigorous was defined as an Apgar score of at least 7 at 5 and 10 minutes. Data on the mothers and infants were obtained from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register. A diagnosis of neonatal seizures was the main outcome measure and the exposures were pregnancy and labor variables. Logistic regression analysis was used and the results are expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).ResultsThe incidence of neonatal seizures was 0.81/1,000 for 656 088 births. Seizures were strongly associated with obstetric emergencies (aOR 4.0, 95% CI 2.2–7.4), intrapartum fever and/or chorioamnionitis (aOR 3.4, 95% CI 2.1–5.3), and intrapartum fetal distress (aOR 3.0, 95% CI 2.4–3.7). Other associated intrapartum factors were: labor dystocia, occiput posterior position, operative vaginal delivery, and Cesarean delivery. Some maternal factors more than doubled the risk: a body mass of more than 40 (aOR 2.6, 95% CI 1.4–4.8), hypertensive disorders (aOR 2.3, 95% CI 1.7–3.1) and diabetes mellitus (aOR 2.6, 95% CI 1.7–4.1).ConclusionA number of intrapartum factors were associated with an increased risk of seizures in vigorous term-born neonates. Obstetric emergencies, intrapartum fever and/or chorioamnionitis and fetal distress were the strongest associated risks. The presence of such factors, despite a reassuring Apgar score could prompt close surveillance.

Incidence of Seizure and Associated Risk Factors in Patients in the Medical Intensive Care Unit (ICU) at Memorial Sloan Kettering Cancer Center (MSK) from 2016-2017.

Background: Seizures and status epilepticus are common neurologic complications in the intensive care unit (ICU) but the incidence in a cancer ICU is unknown. It is important to understand seizure risk factors in cancer patients to properly diagnose the seizure type to ensure appropriate therapy. Methods: We identified patients admitted to the medical ICU at Memorial Sloan Kettering Cancer Center (MSK) from January 2016 to December 2017 who had continuous or routine electroencephalography (EEG) and identified clinical and electrographic seizures by chart review. Results: Of the 1059 patients admitted to the ICU between 2016 and 2017, 50 patients had clinical and/or electrographic seizures (incidence of 4.7%, 95% CI: 3.4-6.0). The incidences of clinical and electrographic seizure were 4.1% and 1.1%, respectively. In a multivariable stepwise regression model, history of seizure (OR: 2.9, 95% CI: 1.1-7.8, P: .03), brain metastasis (OR: 2.5, 95% CI: 1.1-5.8, P: .03), vasopressor requirement (OR: 2.2, 95% CI: 1.0-4.9, P: .05), and age < 65 (2.4, 95% CI: 1.2-5.0, P: .02) were associated with increased risk of seizure (either clinical or electrographic). Obtaining continuous EEG instead of routine EEG increased the yield of seizure detection significantly (OR: 3.9, 95% CI: 1.3-11.1, P: .01). No chemotherapy in the past 30 days, no antibiotic use, vasopressor requirement, and having a brain tumor increased risk of electrographic seizure. Length of continuous EEG > 24 h significantly increased the chances of both clinical and electrographic seizure detection, (OR: 2.6 [95% CI: 1.2-5.7] and 15.0 [95% CI: 2.7-82.5], respectively). Conclusions: We identified known and cancer-related risk factors which can aid clinicians in diagnosing seizures in cancer ICUs. Long-term video EEG monitoring should be considered, particularly given the treatable and reversible nature of seizures.

Tardive Seizures After Electroconvulsive Therapy.

Seizures that occur spontaneously after termination of an electroconvulsive therapy (ECT) seizure are termed tardive seizures. They are thought to be a rare complication of ECT, influenced by risk factors that affect seizure threshold. However, there has been limited review of tardive seizures with modified ECT. We aimed to review the literature to provide clinical guidance for the use of ECT after tardive seizures. PubMed, EMBASE, PsycInfo, and CINAHL databases were searched from inception to May 2021 to identify cases of modified ECT, with evidence of a seizure occurring within 7 days of a terminated ECT seizure. Data for demographic, medical, pharmacological, anesthetic, and ECT variables as well as management strategies were collected. There have been 39 episodes of modified ECT-related tardive seizures published over a period of 40 years. In 97.4% of cases, there was at least 1 identified potential risk factor for seizures, including use of a seizure-lowering medication and/or preexisting neurological injury. Major complications were uncommon (<15% of cases); however, 1 fetal death and 1 subsequent suicide were reported. No case was diagnosed with epilepsy, although around 20% continued on antiepileptic medications. More than half of the included patients were retrialed on ECT, with only 15% developing further tardive seizures. Seizures that occurred spontaneously after the termination of an ECT seizure are a rare complication of modified ECT. Recommencing ECT after a tardive seizure may occur after review of modifiable seizure risk factors and with consideration of antiepileptic medication and extended post-ECT monitoring.

Pharmacokinetic changes for newer antiepileptic drugs and seizure control during pregnancy.

ObjectiveTo investigate pharmacokinetic changes in newer antiepileptic drugs (AEDs) and assess seizure frequencies and risk factors of increased seizures during pregnancy in women with epilepsy (WWE).MethodsA total of 56 pregnancies in 53 WWE who received newer antiepileptic drugs (AEDs) were enrolled. Data on seizure activity and types, daily dose, and AEDs blood levels were derived from routine clinical follow‐up. Changes in AEDs clearance were compared between each trimester and nonpregnant baseline. The ratio of AED levels of each trimester to their targets (nonpregnant baseline) concentrations (RTC) was compared between patients with and without an increased seizure. A binary logistic regression was used to investigate the risk factors contributing to seizure worsening during pregnancy.ResultsIncreased clearances of LTG, LEV, and OXC were observed in all trimesters versus nonpregnant baseline. The peak changes in the clearance of LTG (3.42‐fold baseline clearance) (p < 0.001) and LEV (2.78‐fold) (p < 0.001) occurred in the second trimester during pregnancy, followed by oxcarbazepine (2.11‐fold) in the third trimester (p < 0.03). Plasma concentrations of LTG and LEV during pregnancy were significantly decreased compared to baseline levels, except for OXC. However, no significant differences in RTC values were observed between patients with and without seizure worsening. Some risk factors as seizures for the prior nine months could significantly affect seizure frequency during pregnancy.ConclusionWe found substantial changes in the pharmacokinetics of multiple newer AEDs in WWE, reinforcing the need for therapeutic drug monitoring (TDM) during pregnancy. We would encourage at least one monitoring every trimester and probably more frequently for women with poorly seizure control before pregnancy, and AEDs dose adjustment should keep up with clearance changes. In addition, a well‐controlled seizure nine months before pregnancy could lower the risks of seizure during pregnancy, highlighting the importance of pre‐pregnancy counseling and seizure management before pregnancy.