| Seizures are the most common manifestation of neonatal brain injury. This study attempted to determine the extent of cognitive, neuropsychological, and socioemotional sequelae of neonatal seizures as well as to evaluate prognostic value of proton magnetic resonance spectroscopy (1H-MRS) in pathogenesis of early epileptogenic activity. Participants were English-speaking children ages 3-9 (N=13) who were treated for neonatal seizures at Loma Linda University Children's Hospital and had received gray matter of the occipital region 1H-MRS between 1994 and 2003. Presence of lactate as detected via occipital gray matter short-echo 1H-MRS was associated with poorer VIQ (r = -.614, p = 0.017), PIQ (r = -.581, p = 0.024), FSIQ (r = -.591, p = 0.022), and memory abilities (r = -.516, p = 0.036). VIQ (r = .696, p = 0.041) and PIQ (r =.698, p = 0.041) improved with higher NAA/Cr ratio as measured by intermediate echo 1H-MRS in the occipital gray matter. Presence of lactate was highly indicative of impaired nonverbal reasoning ability (Matrix Reasoning: r = -1.000, p <.000) whereas depressed NAA/Cr suggested poorer visuo-constructional abilities (Block Design: r = .973, p <.000). Greater NAA/Ch ratio in thalamus correlated with better performance in all outcome areas (PIQ: r = .928, p = 0.004; FSIQ: r = .841, p = 0.018). Memory functions improved with increases in NAA/Cr measured in thalamus and basal ganglia. Higher Cho/Cr ratios in the thalami were related to poorer long-term outcomes. Overall, occipital gray matter short echo 1H-MRS was more potent than EEG at predicting children's current cognitive functioning whereas multivoxel intermediate echo 1H-MRS measurements in basal ganglia region and in occipital gray matter were stronger predictors of current memory and learning abilities. Higher frequency of seizures was associated with poorer ability to recall details of short stories (r = -.492, p = .044). The longer the seizures reoccurred; the worse was the child's functioning. Problems with attention (t (11) = 2.093, p = 0.060, two-tailed) were noted in this sample. Participants who lived in a two-parent household tended to exhibit less problem behaviors (r = 0.609, p = 0.036); additionally, younger children who came from less affluent backgrounds were more likely to act out (child's age at assessment (r = -.527, p = 0.039) and family income ( r = -.525, p = 0.049)). Due to small sample size, generalizability is limited. However, further investigations are warranted. |
