Early Anatomical Injury Patterns Predict Epilepsy in Head Cooled Neonates With Hypoxic-Ischemic Encephalopathy.
Early Anatomical Injury Patterns Predict Epilepsy in Head Cooled Neonates With Hypoxic-Ischemic Encephalopathy.
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DOI：
10.1016/j.pediatrneurol.2015.04.009
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发表时间：
2015-08
影响因子：
3.8
通讯作者：
Venkatesan C
中科院分区：
文献类型：
--
作者：
Jung DE;Ritacco DG;Nordli DR;Koh S;Venkatesan C
确定MRI中早期解剖损伤模式是否与接受选择性头部冷却治疗缺氧缺血性脑病的婴儿中新生儿后癫痫的发生相关。一项对2008年至2013年间出生的妊娠≥35周的婴儿进行的回顾性研究，并在西北大学随访至少一年。所有人在第4-5天进行脑部MRI，在复温期间和3 - 6个月大时进行EEG。我们的73例患者的结局良好，平均随访41（± 7）个月。大多数（66%）存活下来，没有癫痫复发，而13（18%）发展为新生儿后癫痫，包括8例婴儿痉挛症。12名婴儿（16%）死亡。最常见的MRI模式是弥漫性脑损伤，累及皮质和皮质下灰质（26/73，35%），其次是皮质和皮质下白色物质损伤（18/73，25%）和MRI正常（16/73，22%）。在13名婴儿（18%）中，除了皮质和皮质下灰质外，脑干也受累; 9名死亡，所有4名存活婴儿均发生婴儿痉挛。18例皮质和皮质下白色物质损伤的婴儿均存活，无新生儿后癫痫。新生儿后癫痫风险与皮质下区域（基底神经节、丘脑±脑干）损伤相关（12/39 vs 1/34，p<0.003）。脑干损伤高度预测婴儿痉挛，而皮质损伤单独预测短期新生儿后癫痫的风险较低。MRI上解剖损伤的位置可以作为婴儿痉挛发展的早期预测因素，并为新生儿缺氧缺血性脑病选择性头部冷却治疗的预后决策提供信息。
To determine whether early anatomical injury patterns in MRI correlate with the development of post-neonatal epilepsy in infants treated with selective head cooling for hypoxic ischemic encephalopathy. A retrospective study of infants ≥35 weeks’ gestation born between 2008 and 2013 and followed for at least one year at Northwestern University. All had brain MRI at day 4–5 and EEGs during rewarming and at 3 to 6 months of age. Outcome was favorable for our cohort of 73 with mean follow-up of 41 (± 7) months. The majority (66%) survived with no seizure recurrence, while 13 (18%) developed post neonatal epilepsy including 8, who had infantile spasms. Twelve infants (16%) died. The most common MRI pattern was diffuse brain injury involving both cortical and subcortical gray matter (26/73, 35%) followed by cortical and subcortical white matter injury (18/73, 25%), and normal MRI (16/73, 22%). In 13 infants (18%), the brainstem was involved in addition to cortical and subcortical gray matter; 9 died and all 4 surviving infants developed infantile spams. All 18 infants with cortical and subcortical white matter injury survived and none developed post neonatal epilepsy. Risk of post neonatal epilepsy was associated with injury involving subcortical regions (basal ganglia, thalamus ± brainstem) (12/39 vs 1/34, p<0.003). Brainstem injury was highly predictive of infantile spams while cortical injury alone predicted low risk for short term post neonatal epilepsy. Location of anatomical injury on MRI can be an early predictive factor for development of infantile spams and inform prognostic decisions in newborns treated with selective head cooling for hypoxic ischemic encephalopathy.