Neonatal Seizures

Dr Gopal Agrawal, Dr R Kishore Kumar
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Investigations
Next proceed with investigations to confirm the diagnosis, to identify the etiology and plan the management with anti-seizure drugs.
First line: Blood glucose, calcium (ionic & total), serum sodium and an arterial blood gas
Second line: Sick neonates with seizures should additionally undergo workup for sepsis (Sepsis screen & blood culture), intracranial infection (CSF studies to rule out meningitis), intracranial bleeding [cranial ultrasonography (CUS) & CT scan brain] and work up for inborn errors of metabolism wherever indicated.
Neuroimaging: Neuroimaging helps to identify the etiology and the extent of severity of the insult.
• A bedside CUS should be done in all neonates with seizures to rule out intracranial bleeds, major malformations and abscesses.
• Non-contrast CT can be performed to rule out subarachnoid/ epidural hemorrhage.
• MRI is the preferred imaging modality to evaluate for the presence of ischemic stroke, brain malformations.

ROLE OF EEG IN NEONATAL SEIZURES
Conventional video-EEG is the gold standard for neonatal seizure detection(5). It should be considered in all neonates to confirm the diagnosis, to identify the etiology and plan the management with anti-seizure drugs, to prognosticate the outcome, and to decide the course of antiepileptic medications. Whenever possible, it should be recorded close to the seizure episode. EEG should be recorded for at least 1 hour duration(6).

References
Neonatal Seizures Neonatal Seizures 09/05/2018
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