Neonatal hypoglycaemic brain injury, a common cause of early-childhood epilepsy in India: A prospective longitudinal study on aetiologies and outcomes.

Aim: To evaluate the aetiologies and long-term seizure outcomes in early childhood epilepsy in a low- to middle-income country (India).

Method: This prospective descriptive study enrolled 231 children with epilepsy onset before age 5 years, over a 12-month period. A comprehensive neuroradiological and genetic evaluation was performed. Differences in epilepsy and neurodevelopmental profiles of the two most common acquired causes - neonatal hypoglycaemic brain injury (NHBI) and neonatal asphyxial brain injury (NABI) - were analysed. Seizure control at 24-month follow-up could be confirmed for 209 patients.

Results: In 172 (74%) patients, an aetiology could be identified. The structural group was the most common (126, 55%), followed by unknown (48, 21%), genetic (41, 18%), and metabolic (5, 2%). At 24-month follow-up, 57 (27%) patients had poor seizure control. NHBI was the most common single cause (50, 22%) of epilepsy. NHBI was associated with focal seizures (p < 0.001), autistic features (p = 0.05), and hypotonia (p = 0.03), while NABI more often led to epileptic spasms (p = 0.05) and hypertonia (p < 0.001).

Interpretation: NHBI was the leading cause of epilepsy in our cohort. These findings highlight the need to revise newborn feeding practices to reduce the long-term burden of epilepsy among Indian children.