Perinatal Hypoxic-hypoglycemic Injury and Epilepsy: A Comprehensive Analysis of Clinical and Laboratory Data in Adults

Objective. Perinatal hypoxia and/or hypoglycemia (PHH) is a serious condition leading to many neonatal deaths worldwide. It causes motor and cognitive deficits, visual disturbances, and seizures in survivors. There is limited information on the clinical course of seizures, EEG and MRI findings in adults. Methods. Adult patients with epilepsy due to PHH were included. Data on patients' demographic and clinical features, age at seizure onset, type and frequency of seizures, antiseizure medications and EEG features were extracted from electronic health records. Seizure outcome was classified as "seizure-free for at least one year at last follow up" versus "continuing seizures". Clinical and laboratory variables that could be associated with seizure outcome were investigated statistically in a subset of patients. Results. Forty-one patients (median age: 32 years) were included. Bilateral cerebral lesions, predominantly affecting the posterior regions, were present in 88% of the cases. Almost 80% experienced focal to bilateral tonic-clonic seizures. Approximately 60% of patients were on polytherapy. Half of the patients were seizure free at last follow-up. Seizure frequency decreased over time in 75% of the cohort. EEG demonstrated background slowing in 44% of patients, with epileptic discharges detected in 27%. The only variable correlated with seizure freedom was older age at seizure onset (P = .034). Conclusion. Almost half of the patients may reach seizure freedom. Seizure frequency decreases in 75% over time. Cranial MRI or EEG findings are not correlated with seizure outcomes. The only variable associated with seizure freedom at last follow up is older age at seizure onset.