HYPOXIC-ISCHEMIC INJURY

Seizures

Focal seizures may be seen, with features referable to the location of the injury within the brain, either acutely or long-term.

Focal to bilateral tonic-clonic seizures can occur, these may have focal features referable to the location of brain injury if this information is carefully sought.

Status epilepticus, including focal status epilepticus, can occur, especially at the time of the acute injury.

CAUTION in young patients with hypoxic-ischemic brain injury in early life, or pre-natally, seizure evolution may include the emergence of epileptic spasms or generalized seizure types, such as atypical absence, atonic and tonic seizures. Developmental and cognitive impairments are more common in this group. If these seizure types are seen, and if seizure control is not achieved with medication, epilepsy surgery may be considered if the region of hypoxic-ischemic injury causing seizures is localized.

CAUTION seizures in neonates and young infants with hypoxic-ischemic brain injury may be subtle clinically, and may require EEG surveillance for detection or confirmation.