Neonatal Seizures

Dr Gopal Agrawal, Dr R Kishore Kumar
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Introduction
Keywords : Subtle seizure, phenobarbitone, Neonate, EEG, Phenytoin

Seizures constitute the most common neurological emergency in neonates. They have a significant impact on neonatal mortality as well as morbidities with adverse neurological outcome.

Definition: Any alteration in behavior, motor or autonomic neurologic function is defined as a seizure. It is further described as(1):
a. Epileptic seizures: clinical seizures associated with EEG changes
b. Non-epileptic seizures: clinical seizures but no EEG manifestations
c. EEG seizures: Abnormal EEG activity, no clinical seizures

Incidence: True incidence is unknown. In term neonates, estimated incidence is 1-5/1000 newborns whereas in preterm neonates, the incidence is estimated at as high as 22%(2-4).

All neonatal seizures are usually classified into one of the four categories as enumerated in Table 1 below.

Table 1: Clinical classification of seizures
Seizure Type Incidence Clinical signs
Subtle Commonest (50%) Lip smacking
Sucking or swallowing movements
Pedaling, swimming
Horizontal or persistent deviation of eyes
Sometimes, apnea associated with eye or oral signs
Tonic 10-20% Sustained increase in muscle tone
Extension or flexion of limbs for few seconds to minutes
Clonic 10-20% Rhythmic muscle jerking in one or more body parts
Myoclonic Least common (1-2%) Lightning-like jerks of extremities
Non-rhythmic repetitive jerking in one or more body parts


After a clinical diagnosis of seizure has been made, detailed workup should be undertaken for underlying etiology, in particular the treatable causes. The antenatal, perinatal history and family history constitute the most important aspects in the initial evaluation. Common etiologies for neonatal seizures are Hypoxic ischemic encephalopathy (HIE), intracranial bleeds, metabolic disturbances (e.g. hypoglycemia, hypocalcaemia, hyponatremia etc) and intracranial infections.


References
Neonatal Seizures Neonatal Seizures 09/05/2018
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