Accidents vasculaires cérébraux ischémiques néonatales et symptomatologie, traitement anti-épileptique, évolution en Basse Normandie, de 2005 à 2017

Abstract : Introduction: neonatal arterial ischemic stroke (NAIS) is common. The cause is unknown. National recommendations for care have been available since October 2017. The majority are revealed by seizures. Status épilepticus is present in 33% of cases. The diagnosis of neonatal seizures is difficult. Anti-convulsive treatments recommended in the neonatal period are not very effective and neurotoxic. Control of seizures is necessary to preserve prognosis. The objective of this work was to describe the anti-convulsive treatments received following a NAIS on a regional retrospective cohort. Method: retrospective analysis of the medical records of the Basse Normandie cohort of NAIS confirmed by imaging between 2005 and 2017, by identifying the risk factors, the clinic, the received anti-convulsive treatments and the evolution. Result: thirty-three of the 35 cases received an anti-convulsive treatments. The control of seizures required only phenobarbital in 60 % of cases, in 31% phenobarbital / phenytoin and in 6% clonazepam. Six percent presented a status epilepticus. Newborns who required anti-convulsive treatments combination convulsed earlier (<24h of life), despite earlier administration of phenobarbital and at higher doses. AVCian in this case tended to concern the territory of the superficial middle cerebral artery. Conclusion: all newborns hospitalized for AVCian experienced seizures. Phenobarbital is insufficient in case of severe seizures, when the AVCian concern the territory of the superficial middle cerebral artery. Reliable studies need to evaluate new anti-convulsive treatments.
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Benoît Duport. Accidents vasculaires cérébraux ischémiques néonatales et symptomatologie, traitement anti-épileptique, évolution en Basse Normandie, de 2005 à 2017. Médecine humaine et pathologie. 2018. ⟨dumas-02025279⟩

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