Faugrel Electrographic seizures in preterm and full-term neonates: The commoner of these are: Cranial ultrasonography, brain imaging with X-ray computed tomography CT scan and preferably magnetic resonance honatale MRI 37 should be used for the detection of structural abnormalities such as malformations of cortical development, intracranial haemorrhage, hydrocephalus and cerebral infarction. The diagnosis and management of the epilepsies in adults and children in primary and secondary care. Diagnosis and management of neonatal seizures. Etiology of convulsions in neonatal and infantile period.
|Published (Last):||22 March 2011|
|PDF File Size:||18.6 Mb|
|ePub File Size:||2.74 Mb|
|Price:||Free* [*Free Regsitration Required]|
Causes[ edit ] Neonatal seizures have a number of causes. Determining the cause of a confirmed seizure is important because treatment and prognosis vary based on underlying etiology of the seizure. In contrast to seizures that occur in other age groups, seizures that occur during the neonatal period are most often caused by the following processes: Hypoxic-Ischemic Encephalopathy : This is the most common cause of seizures in the neonatal period.
Congenital central nervous system malformations: Lissencephaly, polymicrogyria, and tuberous sclerosis are specific entities known to cause seizures due to defects in brain tissue development. Since prognosis is poor and often these disorders are genetic, identification of this etiology is of utmost importance to be able to counsel parents appropriately.
Inborn Errors of Metabolism : Inborn errors of metabolism can cause physiologic conditions that result in seizures. These errors are genetic and often are accompanied by other symptoms such as lethargy, poor feeding, and low tone. Several classification systems exist for seizures caused by inborn errors of metabolism, one of which separates causes into problems with neurotransmitter metabolism, energy production, and biosynthetic substances crucial for brain formation.
Substance-Related: Neonatal abstinence syndrome occurs when maternal drug use before birth results in a fetal withdrawal syndrome. Substances include alcohol, cocaine, narcotics, tricyclclic antidepressants, or other sedatives.
Seizures can be prevented from occurring if the symptoms of withdrawal are recognized and treated early. The amplitude-integrated trace is in the top half of the screen displaying left- and right-sided traces.
There is a normal baseline and upper limit, sleep-wake cycling, and no seizures. Seizure activity in a neonate is difficult to diagnose, as many seizures have no clinical correlate. Altered level of consciousness is often the only clue, and in a neonate this can be difficult to accurately assess.
Thus, diagnosis relies on attempting to directly measurement the abnormal electrical activity in the brain with electroencephalography EEG. EEG is combined with video recording of the infant to correlate any seizure movements with EEG recordings. Conventional continuous multichannel conventional EEG is the gold standard for diagnosis of epileptiform activity, but requires expert interpretation. Newer amplitude integrated EEG aEEG also termed cerebral function monitoring, or CFM allows easier monitoring of brain activity, but may not allow identification of short duration, low amplitude, or very high frequency seizure activity.
Determining the cause[ edit ] Since many causes of seizures can be rapidly reversed and longterm sequelae prevented, evaluation of underlying cause is of utmost importance.
Evaluation for infection with blood counts, lumbar puncture , and empiric treatment with antibiotics often occurs during EEG monitoring. Blood glucose and electrolyte testing can identify metabolic problems that can be corrected. Further testing includes evaluation for genetic causes and other more rare metabolic causes. Differential diagnosis[ edit ] Infants can exhibit stereotyped movements that may be hard to distinguish from seizure activity.
Since many of these non-seizure movements are not dangerous and require no treatment, differentiation from actual seizure activity is useful. It is characterized by a tremor that is especially prominent during sleep or periods of agitation. Gaze deviation or eye movements do not occur. Benign neonatal sleep myoclonus BNSM is another common movement that can be mistaken for a seizure.
It is characterized by jerking limb movements only during sleep, and stop with waking of the infant. BNSM typically occurs later in infancy, but can occur during the neonatal period. Treatment[ edit ] Once diagnosis is made, the goals of management are to identify the cause of the seizure, stop the seizure activity, and maintain physiologic parameters such as oxygenation, ventilation, blood glucose, and temperature.
Treatment greatly depends on the cause of the seizure. For example, infectious causes of seizures meningitis, meningoencephalitis , are often treated with antimicrobials antibiotic, antifungal, or antiviral medications. Similarly, electrolyte or glucose abnormalities are treated by repleting or lowering the offending electrolyte or sugar. If the cause of the seizures are unlikely to be easily or quickly corrected, once diagnosis of a seizure is made, the mainstay of treatment is pharmacotherapy with anti-epileptic drugs.
A systematic review found that most practitioners use phenobarbital or phenytoin. Benzodiazepines are often used as second line treatment if treatment with phenobarbital does not result in clinical improvement. Research is ongoing on use of other anti-epileptics that are commonly used in older children and adults are safe or efficacious to use in neonates.
Part of the challenge of anticonvulsant drug treatment during the neonatal period is that the immature excitatory and inhibitory neurotransmitter system results in few effective drug targets. Controversy remains with the extent of damage the seizures themselves cause. Clinician consensus is that frequent or intractable seizures status epilepticus leads to neuronal damage and are associated with later neurodevelopment problems. Studies have identified risk factors for poor outcomes after neonatal seizures.
Infants that are premature, have hypoxemic ischemic encephalopathy, CNS infection, severe intraventricular hemorrhage, structural central nervous system defect, or severely abnormal EEG tracings tend to do worse than infants with focal strokes, transient metabolic issues hypoglycemia, hypocalcemia , or clinical seizures without EEG abnormalities.
Unfortunately, the answer is rarely clear cut as it depends greatly on the underlying cause. Estimations range between per 1, live-births,  though the actual rate of seizures during this period may be higher due to lack of accurate diagnosis of sub-clinical seizure activity without continuous EEG monitoring.
Acute causes of seizures hypoxemic ischemic encephalopathy, infection, intracranial hemorrhage, stroke, etc are more common than first-episode of neonatal epilepsy syndromes. Seizures occur during the neonatal period at a higher rate than in any other period of life. Seizures in the developing brain are more common than in a mature brain for several reasons.
First, the developing brain is hyperexcitable due to excess in excitatory glutaminergic neurons and immaturity of inhibitory gamma-amino butyric acid GABA neurons. Preterm infants are at especially high risk for seizures for this reason. Algorithms and machine learning have been studied, however logistical and mathematic challenges remain.
Akinogis Efficacy of lamotrigine in refractory neonatal seizures. Apnoeic, convulsino, clonic and subtle seizure of motor automatisms associated with various ictal EEG patterns and locations. Such neonatal seizures are considered self-limited, and thus the term neonatal epilepsy is not used to describe these seizures. Blood glucose and electrolyte testing can identify metabolic problems that can be corrected. Inborn errors of metabolism such as urea cycle disorders are rare.
CONVULSION NONATALE PDF