A 2013 prospective cohort study funded by the National Institute of Health (NIH) found that there is an increased risk of seizures and epilepsy in infants and children who suffered an intracerebral (brain) hemorrhage (ICH) (2).
Intracerebral hemorrhage is a high risk for seizures and epilepsy
The study analyzed 73 children with spontaneous ICH between 2007 and 2012. 20 of the subjects experienced perinatal ICH (ICH occurring between 37 weeks gestation and 28 days of age) and 53 experienced childhood ICH (ICH occurring between 28 days and 18 years of age) (2). These children had follow-up stroke clinic visits, where they were studied for seizure activity. Additionally, all hospital admissions, telephone communications, and emergency room visits were checked for further seizure information.
The study found that acute symptomatic seizures – seizures occurring at presentation of ICH or up to 7 days afterward – were documented in 60% of perinatal subjects and 36% of childhood subjects (2).
The study also found that in the first two years following intracerebral hemorrhage, one-third of patients will experience a single remote symptomatic seizure and less than 15% will develop epilepsy (2). 28% of study participants who underwent continuous EEG monitoring were found to have subclinical EEG-only seizures (seizures with no outward symptoms).
Infants and children with ICH must be closely monitored
These findings have serious implications about the necessity of close monitoring following ICH. Many seizures had no symptoms and were detectable only by EEG. This study suggests that EEG monitoring should be routinely performed on infants and children who experienced an ICH.
Elevated intracranial pressure (ICP) also a risk factor for seizures and epilepsy
In examining potential risk factors for symptomatic seizures and epilepsy, the study also found that when elevated intracranial pressure (ICP) is present, immediate intervention is required due to the fact that increased ICP is a risk factor for seizures and epilepsy (2).
ICH and high ICP requires close monitoring and prompt intervention
Seizure activity in infants must be prevented because seizures can kill brain cells and cause permanent brain damage. Even isolated, brief seizures can injure the brain. The longer a seizure lasts, the more damage it causes. EEG monitoring of infants and children with ICH is crucial so that physicians can start to treat the seizures and underlying causes the instant they occur. Additionally, when babies and children have elevated ICP, the medical team must promptly provide treatment in order to prevent seizures and epilepsy.
ICH often caused during labor and delivery
The study focused on spontaneous ICH, which is intracerebral hemorrhage that occurs spontaneously in a previously healthy newborn. Intracerebral hemorrhage, in general, however, can be caused by birth trauma or hypoxic-ischemic encephalopathy (HIE) (3).
Trauma during delivery is the main cause of intracranial hemorrhage, which includes intracerebral hemorrhage (4). Babies are at an increased risk of having an intracranial hemorrhage in the following instances:
- Use of forceps or vacuum extractors
- Breech delivery
- Prolonged labor
- Low birth weight infants
- Premature infants
Medical negligence and ICH / elevated ICP
All babies and children at risk for ICH, ICP and seizures require close monitoring and prompt intervention. If a physician fails to closely monitor a baby or child with ICH, it is negligence. Failure to treat ICP also constitutes negligence. If the negligence results in injury to the infant or child, it is medical malpractice.
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- Infant Intracranial Hemorrhages (Brain Bleeds) and Birth Trauma
- Subarachnoid Hemorrhage in Newborns
- Infant Brain Bleeds: Intraventricular Hemorrhages (IVH)
- Subdural Hemorrhages/Hematomas
- Cerebral & Intracerebral Hemorrhage. (n.d.). Retrieved July 22, 2019, from https://my.clevelandclinic.org/health/diseases/14480-intracranial-hemorrhage-cerebral-hemorrhage-and-hemorrhagic-stroke
- Beslow, L. A., Abend, N. S., Gindville, M. C., Bastian, R. A., Licht, D. J., Smith, S. E., … Jordan, L. C. (2013). Pediatric intracerebral hemorrhage: acute symptomatic seizures and epilepsy. JAMA neurology, 70(4), 448–454. doi:10.1001/jamaneurol.2013.1033
- Bergman, Ira., Bauer, Roberta., et. al. Intracerebral Hemorrhage in the Full-Term Neonatal Infant. Pediatrics, Vol. 75 No. 3 March 1985.
Ojumah, N., Ramdhan, R. C., Wilson, C., Loukas, M., Oskouian, R. J., & Tubbs, R. S. (2017). Neurological Neonatal Birth Injuries: A Literature Review. Cureus, 9(12), e1938. doi:10.7759/cureus.1938