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Definition
Seizures are transient disturbances
in brain function manifesting as
episodic impairments in
consciousness in association with
abnormal motor or automatic
activity.
DISORDER
Hypoxemia, ischemia,
and hypoglycemia
Hypoxemia, ischemia
and hypoglycemia
Pyridoxine dependency
Classification of Neonatal
Seizures
Clinical
Electroencephalographic
Classification
I. Clinical Seizure
Subtle
Tonic
Clonic
Myoclonic
II. Electroencephalographic
seizure
Epileptic
Non-epileptic
..Clinical Classification
1. Subttle
Usually occurs in association with other
types of seizures and may manifest with:
Stereotypic movements of the
extremities such as
bicycling or swimming movements.
Deviation or jerking of the eyes with
repetitive
blinking
Drooling, sucking or chewing
movements.
Apnea or sudden changes in respiratory
..Clinical Classification
2. Tonic
Primarily in Preterm
..Clinical Classification
3. Clonic
..Clinical Classification
4. Myoclonic
Focal, multifocal, or generalized
Focal myoclonic seizures typically
involve the flexor muscles of the
extremities.
Multi-focal myoclonic seizures present
as asynchronous twitching of several
parts of the body.
Generalized myoclonic seizures
present as massive flexion of the head
and trunk with extension or flexion of
the extremities. They are associated
Electroencephalographic seizure
I. Epileptic
Consistently associated with electrocortical seizure activity on the EEG
Cannot be provoked by tactile stimulation
Cannot be suppressed by restraint of
involved limb or repositioning of the infant
Related to hyper synchronous discharges
of a critical mass of neuron
Electroencephalographic
seizures
II. Non-epileptic
No electro-cortical signature: seizures
are initiated in the subcortical area and
are not usually associated with any EEG
changes.
Provoked by stimulation
Suppressed by restraint or repositioning
Brainstem release phenomena (reflex)
COMMON
UNCOMMON
Subtle
+*
Clonic
Focal
+
Multifocal
+
Tonic
Focal
+
Generalized
+
Myoclonic
Focal, multifocal +
Generalized
+
--------------------------------------------------------------------------------------------------------------*Only specific varieties of subtle seizures are commonly associate with simultaneous
Electroencephalographic seizure activity.
Volpe JJ.Neonatal Seizures:Neurology of the Newborn.4 th ed.
JITTERINESS
SEIZURE
Clonic jerking
-
+
+
-
+/-
------------------------------------------------------------------------------------------------------------------
......Jitteriness (cont)
often
Diagnosis of Seizures
A. History
Obtain a good maternal and obstetric history;
Pregnancy history is important
Search for history that supports TORCH infections
History of fetal distress, preeclampsia or maternal
infections
Maternal drug history
Delivery history:
type of delivery and antecedent events
Apgar scores offer some guidance : Low Apgar score
without the need for resuscitation and subsequent
neonatal intensive care is unlikely to be associated with
neonatal seizures
..Diagnosis of Seizures
Postnatal history
Neonatal seizures in infants without uneventful
antenatal history and delivery may result from
postnatal cause
Tremulousness may be secondary to drug
withdrawal or hypocalcemia
Temperature and blood pressure instability may
suggest infection.
Diagnosis of Seizures
A. Physical examination
Determine :
Gestational age
Blood pressure
Presence oh skin lesion
Precense of hepatosplenomegaly
B. Neurologic evaluation
C. Notation of the seizure pattern ( onset, spread,
nature, duration, and level of conciousness)
Laboratory Investigations
Primary tests
Blood glucose
Blood calcium and magnesium
Complete blood count, differential
leukocytic count and platelet count
Electrolytes
Arterial blood gas
Cerebral spinal fluid analysis and cultures
Blood cultures
19
Management of Seizures
Management goals
To minimize brain damage
Achieve systemic homeostasis
(airway, breathing and circulation).
Correct the underlying cause if
possible.
21
22
23
24
Medical Management :
10% dextrose solution (2cc/kg IV) empirically to
any seizing neonate.
Anticonvulsant drugs
Calcium gluconate (200mg/kg IV), if
hypocalcemia is suspected .
Magnesium sulfate 50%, 0.2ml/kg or 2 mEq/kg.
In pyridoxine dependency give pyridoxine
50mg IV as a therapeutic trial. Seizures will
stop within minutes.
Antibiotics in suspected sepsis.
Be prepared to manage any complication
Stopping
26
27
Determinants of Duration of
anticonvulsant therapy for neonatal
seizures
Electroencephalogram
Prognosis
Two most useful approaches in utilizing outcome
EEG
Complications
Cerebral palsy
Hydrocephalus
Epilepsy
Spasticity
Feeding difficulties
References
1.Volpe JJ.Neonatal seizures. In:Neurology of the newborn.4th
ed.Philadelphia,Pa:WB Saunders's Co;2001:178-214
2.Hahn J,Olson D.Etiology of neonatal
seizures.NeoReviews.2004;5:327-335
3.Riviello,J.Drug therapy for neonatal seizures:Part
I.NeoReviews.2004;5:215-220
4.Riviello,J.Drug therapy for neonatal seizures:Part
II.NeoReviews.2004;5:262-268
5.Fanaroff A,Martin R,Neonatal seizures.In:Neonatal-Perinatal
Medicine-Diseases of the fetus and infant.6th
ed.St.Louis,MO:Mosby-Yearbook Inc.1997:899-911
6.Sheth R, Neonatal seizures;Emedicine.com
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