Neonatal Seizures
About 2–4/1000 live births suffers of seizure disorder. Usually occur 12–48hr after delivery. Can be generalized or focal, and tonic, clonic, or myoclonic.
Subtle seizure patterns (lip-smacking, limb-cycling, eye deviation, apnoeas, etc.) can be difficult to identify or differentiate from other benign conditions that may mimic seizures as:
Startle or Moro reflexes, normal jittery’ movements (fine, fast limb movements that are abated by holding affected limb), Sleep myoclonus (REM movements).
*hypoxic ischaemic encephalopathy (HIE).
*intracranial haemorrhage.
*cerebral infarction (ischaemic or haemorrhagic).
*cerebral oedema.
*birth trauma.
-CNS infection:
*meningitis (e.g. GBS, coliforms).
*encephalitis (e.g. HSV, CMV).
-Cerebral malformations.
*hypo- or hypernatraemia.
*hypocalcaemia, hypomagnesia.
*pyridoxine dependent seizures.
*non-ketotic hyperglycinaemia.
-Neonatal withdrawal from maternal medication or substance abuse.
* benign familial neonatal seizures (autosomal dominant).
* early myoclonic encephalopathy.
With improved access to neuroimaging, fewer infants are being categorized as ‘benign’ or ‘idiopathic’ seizures. Neonatal stroke is increasingly recognized.
When to start anticonvulsants?
usual indication is >3seizures/hr or single seizure lasting >3–5min
particularly if evidence of cardio-respiratory compromise.
Subtle seizure patterns (lip-smacking, limb-cycling, eye deviation, apnoeas, etc.) can be difficult to identify or differentiate from other benign conditions that may mimic seizures as:
Startle or Moro reflexes, normal jittery’ movements (fine, fast limb movements that are abated by holding affected limb), Sleep myoclonus (REM movements).
Causes:
-Brain injury as:*hypoxic ischaemic encephalopathy (HIE).
*intracranial haemorrhage.
*cerebral infarction (ischaemic or haemorrhagic).
*cerebral oedema.
*birth trauma.
-CNS infection:
*meningitis (e.g. GBS, coliforms).
*encephalitis (e.g. HSV, CMV).
-Cerebral malformations.
-Metabolic:
*Hypoglycaemia.*hypo- or hypernatraemia.
*hypocalcaemia, hypomagnesia.
*pyridoxine dependent seizures.
*non-ketotic hyperglycinaemia.
-Neonatal withdrawal from maternal medication or substance abuse.
-Kernicterus.
-Rare syndromes:* benign familial neonatal seizures (autosomal dominant).
* early myoclonic encephalopathy.
With improved access to neuroimaging, fewer infants are being categorized as ‘benign’ or ‘idiopathic’ seizures. Neonatal stroke is increasingly recognized.
Treatment of neonatal seizures:
Immediate: give oxygen,maintain airway, insert IV canula.When to start anticonvulsants?
usual indication is >3seizures/hr or single seizure lasting >3–5min
particularly if evidence of cardio-respiratory compromise.
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