Neonatal seizures

Abstract

Neonatal seizures are frequently manifested by subtle movements that are referable to brain stem structure, ie, nystagmus, conjugate eye movements, posturing, sucking movements, and so forth. Electroencephalogram (EEG) confirmation of abnormal movements is essential in diagnosing seizures in the neonate. Clinical seizure signs are often a clue to etiology. Metabolic abnormalities must always be considered, and blood gases, calcium, magnesium, glucose, and ammonia obtained. Neonatal seizures are an indication for cerebrospinal fluid examination. Specific metabolic abnormalities are treated with metabolic approaches, not conventional anticonvulsant drugs. Hypertensive encephalopathy is treated by controlling blood pressure, and not through anticonvulsant drugs. Critically ill infants bind anticonvulsants in an unpredictable fashion, and unbound or free anticonvulsant drug concentrations should be used to guide therapy. Phenobarbital is the most commonly used drug in treating nonmetabolic seizures. Doses to achieve free concentrations of at least 35 mg/L should be used. Use in vitro binding determinations with this formula to calculate loading doses. Dose is 25 mg/kg multiplied by volume and distribution (1 L/kg) divided by % free. Phenytoin is the second most commonly used agent, and doses should be calculated to achieve, but not exceed, 3 mg/L. Dose is 3 mg/kg multiplied by volume and distribution (1 L/kg) divided by % free. Benzodiazepines, notably lorazepam and diazepam are used at doses of 0.15 mg/kg and 0.3 mg/kg, respectively.

Developmental factors regulating susceptibility to perinatal brain injury and seizures

“…Unlike in the preterm brain, however, the white matter is not a predominant focus for injury. Seizures occurring in this population can be very refractory to antiepileptic drugs commonly used in adults, such as phenobarbital and benzodiazepines [61][62][63]. Indeed hypoxic encephalopathy is the leading cause of refractory neonatal seizures in the term infant [60,63].…”

Maternal water intoxication as a cause of neonatal seizures

“…Seizures occur in 1−2% of infants in NICUs 1 . They are a common manifestation of serious central nervous system disease.…”

“…Seizures occur in 1-2% of infants in NICUs. 1 They are a common manifestation of serious central nervous system disease. Early neonatal seizures are most commonly a result of hypoxic-ischaemic encephalopathy, intracranial haemorrhage or infarction, hypoglycaemia, hypocalcaemia and inadvertant drug administration (e.g.…”

Developmental factors in the pathogenesis of neonatal seizures

“…The most common cause of neonatal seizures is hypoxic/ischemic encephalopathy, which is approximately 1-2/1000 live births [4][5][6]. Seizures occurring in this population can be very refractory to antiepileptic drugs commonly used in adults, such as phenobarbital and benzodiazepines [7][8][9][10]. Neonatal seizures are associated with a high rate of long-term disability and mortality [11].…”