Etiological and clinical profile of neonatal seizures in a highly consanguineous population

A prospective longitudinal study was conducted on all neonates admitted with a diagnosis of neonatal seizures in the neonatal intensive care unit of Jordan University Hospital Amman from April 2003 to March 2005 to examine the cause and clinical profile of seizures in a community, which culturally favors consanguineous marriages. Of 35 neonates studied, inborn errors of metabolism accounted for 28.6%, hypoxic ischemic encephalopathy for 17.1% and cerebral malformations for 14.3%. The consanguinity rate among parents of affected neonates was 54%, and 22.9% of these probands had a similarly affected sibling. Compared with 78 matched controls, consanguinity proved to be a risk factor for neonatal seizures (P = 0.007, odds ratios = 3.02; 95% confidence intervals 1.22 to 7.51). The hospital-based incidence of seizures was 5.6 per 1000 live births. Poor outcome in the form of mortality or morbidity was present in 67.8% of the cases. Early-onset seizures and status epilepticus accounted in 40% and 22.9% of cases respectively, with subtle seizures being the commonest type. Based on our results, inborn errors of metabolism and cerebral malformations make a significant contribution to the etiology of clinical neonatal seizures. This is accounted for by the consanguineous population being at risk for a number of neurogenetic disorders leading to convulsions on one hand and by improved methods of diagnosis of neonatal seizures on the other. In future, genetic counseling may help to minimize the contribution of underlying genetic factors to neonatal seizures in our community.