Project Details

Predictors of Cognitive Disability and Executive Dysfunction After Acute Symptomatic Neonatal Seizures

Melisa Carrasco McCaul, MD, PhD

Summary

BACKGROUND: Seizures during the neonatal period occur at a rate of 1.10 – 5.5 per 1,000 live births and constitute a neurological emergency requiring prompt recognition and treatment. Acute symptomatic neonatal seizures (ASNS) among term infants are associated with significant morbidity and mortality, including poor motor and cognitive outcomes, as well as an elevated risk for epilepsy. GAP: Significant gaps in knowledge persist; in particular, long-term cognitive outcomes beyond early infancy have been particularly difficult to predict in children with ASNS. Because the natural history of executive function (EF) abilities in young children with ASNS (younger or equal to 24 months of age) has yet to be described in detail, our study will aim to address this gap. HYPOTHESIS: We hypothesize that ASNS patients with more severe brain injury on MRI during the neonatal period will have worse EF and cognitive abilities at 12 & 24 mos, compared to ASNS patients without significant injury on MRI and healthy controls, including worse attentional and working memory abilities. We also hypothesize that ASNS patients will display more immature resting state networks, with lower high frequency activity, in comparison to healthy controls, and that lower high frequency frontal activity will predict greater EF/cognitive deficits in ASNS patients at 12 & 24 mos. METHODS: Data collection is underway, towards pursuing a prospective, exploratory, observational cohort that will examine potential early biomarkers for EF and cognitive disability in infants following ASNS. Biomarkers of interest to our group to be evaluated as part of this study will include: a) degree of severity of brain injury on neonatal (term) MRI, b) look duration, a behavioral measure of infant attention at 6 months of age, and c) frontal EEG power spectra during baseline and play at 6 months of age. RESULTS: Data collection is ongoing, with n=21 participants already recruited to this study. IMPACT: Our proposed study would be the first to systematically follow ASNS patients in order to understand cognitive development over the first 2 years following ASNS. The establishment of early biomarkers for identification of patients at higher risk for cognitive disability will help streamline resources, so that patients at greater risk for cognitive disability are provided with early interventions aimed to decrease long-term morbidity. Website Link: https://neurology.wisc.edu/research-and-labs/trees-lab/