Epilepsy Secondary to Neonatal Hypoglycemic Brain Injury (NHBI): Electroclinical Characteristics, Imaging, and Long-Term Outcome

Background: Neonatal hypoglycemic brain injury (NHBI) is a significant cause of structural epilepsy in children, often associated with long-term neurodevelopmental impairments. Despite its frequency, electroclinical evolution, syndromic patterns, and imaging, EEG correlations in NHBI remain underexplored. This study aimed to characterize seizure types, epilepsy syndromes, EEG patterns, imaging features, and long-term outcomes in children with epilepsy secondary to NHBI.

Methods: We retrospectively reviewed 124 consecutive patients evaluated between January 2015 and January 2021 at a tertiary epilepsy center. Inclusion criteria were a history of neonatal hypoglycemia or MRI evidence of parieto-occipital gliosis consistent with NHBI. Detailed clinical data, video-EEG findings, epilepsy syndromes, and neuroimaging features were analyzed. EEGs were classified into four patterns (1a–4b) reflecting severity and syndromic correlation. Statistical analysis included chi-square and Spearman correlation to assess associations between EEG severity, MRI lesion characteristics, developmental delay, and clinical outcomes.

Results: Among 124 patients (83% male; mean age 12 ± 6 years), 77.5% had focal onset seizures, and 54% exhibited epileptic encephalopathy (EEG patterns 2a–4b). Lennox–Gastaut syndrome was the most frequent epilepsy syndrome (39.5%), followed by focal epilepsy (46%). MRI showed parieto-occipital or more extensive gliosis except in one. Only parieto-occipital gliosis was seen in 95 patients, with 29 unilateral and 58 bilateral lesions; significant asymmetry predicted focal ictal rhythms but did not correlate with EEG severity. Developmental delay (76.7%) and visual impairment (35%) were common, and EEG severity was significantly associated with developmental delay (p < 0.001).

Conclusion: Epilepsy following NHBI frequently evolves into refractory epileptic encephalopathy with high developmental and visual morbidity. Early syndrome identification and individualized management, including surgical evaluation in select asymmetric lesions, are crucial for optimizing outcomes.

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Publikationsverlauf

Artikel online veröffentlicht:
24. Oktober 2025