title: Seizures and magnetic resonance imaging-detected brain injury in newborns cooled for hypoxic-ischemic encephalopathy.
abstract: OBJECTIVE
  To describe the association between electrographically detected seizures and brain injury evaluated by magnetic resonance imaging in newborns treated with hypothermia.
  
  
  METHODS
  A total of 56 newborns treated with hypothermia were monitored using video electroencephalography through cooling and rewarming, and then imaged at a median of 5 days. The electroencephalograms were reviewed for indications of seizure and status epilepticus. Moderate-severe injury detected on magnetic resonance imaging was measured using a classification scheme similar to one predicting abnormal outcome in an analogous population.
  
  
  RESULTS
  Seizures were recorded in 17 newborns (30%), 5 with status epilepticus. Moderate-severe injury was more common in newborns with seizures (relative risk, 2.9; 95% CI, 1.2-4.5; P=.02), and was present in all 5 newborns with status epilepticus. Newborns with moderate-severe injury had seizures that were multifocal and of later onset, and they were more likely to experience recurrent seizures after treatment with 20 mg/kg phenobarbital. Newborns with only subclinical seizures were as likely to have injury as those with seizures with a clinical correlate (57% vs 60%).
  
  
  CONCLUSIONS
  Seizures represent a risk factor for brain injury in the setting of therapeutic hypothermia, especially in neonates with status epilepticus, multifocal-onset seizures, and a need for multiple medications. However, 40% of our neonates were spared from brain injury, suggesting that the outcome after seizures is not uniformly poor in children treated with therapeutic hypothermia.
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Glass
authors.forename: Kendall B
authors.initials: KB
authors.lastname: Nash
authors.forename: Sonia L
authors.initials: SL
authors.lastname: Bonifacio
authors.forename: A James
authors.initials: AJ
authors.lastname: Barkovich
authors.forename: Donna M
authors.initials: DM
authors.lastname: Ferriero
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Sullivan
authors.forename: Maria Roberta
authors.initials: MR
authors.lastname: Cilio
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D004351:Drug Resistance; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000473:pathology / Q000628:therapy*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D017694:Rewarming; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000175:diagnosis / Q000453:epidemiology; D014741:Video Recording
chemical_list: D000927:Anticonvulsants