Newborns with low Apgar scores - indicating that they have serious physical difficulties - are more likely to develop epilepsy during childhood and early adulthood than those with higher scores, a Danish study shows.

Apgar scoring is a method of quickly checking newborns, based on their heart rate, breathing, muscle tone, response to a stimulus, and color. The maximum score is 10, and the assessment is made at 1 minute and 5 minutes after babies are born.

The new findings suggest that “prenatal or perinatal factors play a larger role in the (cause) of epilepsy than has previously been recognized,” say Dr. Yuelian Sun, from the University of Aarhus, and associates.

The researchers identified children born between 1978 and 2002, as documented in the Danish Civil Registration System. Apgar scores at birth were obtained from the Danish Medical Birth Register, and information regarding epilepsy was extracted from the National Hospital Register.

The investigators report in the research journal Epidemiology that, among the roughly 1.5 million live-born children, 16,455 cases of epilepsy were diagnosed by the end of 2002. This is equivalent to an average incidence rate of 91.7 cases per 100,000 persons per year of follow-up.

Epilepsy incidence increased consistently with decreasing 1- and 5-minute Apgar scores. For example, the incidence per 100,000 person-years was 628 for those with 5-minute Apgar scores of 1 to 3, versus 86 for those with scores of 10.

The incidence of epilepsy was 8 times higher among children with Apgar scores of 1 to 3 at both 1 and 5 minutes compared with children with scores of 10 at both time points.

The occurrence of epilepsy associated with low Apgar score was greatest during the first year of life, but the risk remained elevated throughout childhood and up to 25 years of age.

Potential causes of epilepsy related to pregnancy and birth “could be infections, maternal lifestyle factors, maternal complications during pregnancy, and factors related to the delivery process,” Sun’s team writes.

They believe that more research looking into the fetal and perinatal origins of epilepsy is warranted.

SOURCE: Epidemiology, May 2006.