Neonatal Seizures: Problems in Diagnosis and Classification

Mizrahi, Eli M.

doi:10.1111/j.1528-1157.1987.tb05757.x

Cited by 53 publications

(31 citation statements)

References 38 publications

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“…12,13 In a study by Rose and Lombroso of 137 cases, Hypocalcemia 28 (20.4%), CNS malformations 13 (9.5%), hypoglycemia 7 (5.1%) and congenital malformations of CNS 11 (8.0%) were the cause of seizures which is in contrary to the findings in our study.…”

Section: Resultscontrasting

confidence: 56%

Neonatal seizures and outcome in a NICU of a tertiary care hospital of Andhra Pradesh-an two year study

Nagaram

Piduru

Munagala

2017

Int J Contemp Pediatr

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Background: Seizures are the most frequent clinical manifestation of central nervous system dysfunction in the newborn with the incidence varying from 1-5%. Neonatal seizures often signal an underlying ominous neurological condition, most commonly hypoxia-ischemia, and others include stroke, intraventricular hemorrhage or intraparenchymal hemorrhage, meningitis, sepsis, and metabolic disorders. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity and "prime" the brain to increased damage from seizures later in life. The present study was undertaken to delineate the various aspects of neonatal seizures, with special reference to etiology, clinical spectrum, and outcome in the Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital.Methods: A prospective cross sectional study was conducted in an NICU of a tertiary care hospital with 65 neonates in the study group for a period of 2 years. Gestational age assessment is done by modified Ballard’s scoring system and detailed neurological assessment was done. Antenatal history of mother, demographic data, and clinical history of neonate was noted and evaluated. Laboratory investigations were done and results noted and outcome was recorded.Results: Subtle seizure was the commonest (40%) clinical seizures in our study followed by tonic (21.5%). Tonic seizures were common in preterm and in full term subtle seizures. Babies with myoclonic seizures had 100% mortality. Hypoxic ischemic encephalopathy was the commonest cause (41.5%) of mortality in our study. The worst outcome was with CNS malformation (50%). A total of 10 deaths were recorded (15.4%) with maximum association in cases with history of onset 7 days (100%).Conclusions: Neonatal seizures are common and may be the first manifestation of neurological dysfunction after a variety of insults. Seizures may interfere with cardio-respiratory function and nutrition and may have detrimental effects on cerebral development. Global cerebral hypoxia-ischemia is the most common etiology of neonatal seizures, followed by intracranial bleed, hypoglycemia, septicemia, hypocalcemia, BE, CNS malformations.

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Section: Resultscontrasting

confidence: 56%

Neonatal seizures and outcome in a NICU of a tertiary care hospital of Andhra Pradesh-an two year study

Nagaram

Piduru

Munagala

2017

Int J Contemp Pediatr

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Section: The Neonatal Brain and Age-specific Neonatal Seizuresmentioning

confidence: 99%

“…Synaptic currents are often slower (19), neurotransmitters play trophic roles (20), and circuits are not fully mature (21). These facts predict that seizures may propagate poorly and may thus remain subclinical, or manifest as fragmented motor activity (22,23).From a molecular standpoint, there are developmental changes in both excitatory and inhibitory neurotransmission (24-34) excitatory and inhibitory components of synaptic transmission do not develop concurrently (33,35). GABAergic synapses seem to be the first to function (36).…”

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confidence: 99%

The Brain, Seizures and Epilepsy Throughout Life: Understanding a Moving Target

Baram

2012

Epilepsy Curr

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The Scope of the Problem The incidence of seizures and of epilepsy varies throughout life, peaking in neonates and children and increasing again after the age of 50 (1-4). In addition to the quantitative measure of the incidence of seizures, the type of seizures (and of epilepsy syndromes) varies with age: for example, febrile seizures take place in infants and children (1, 5-7), whereas the incidence of post-stroke epilepsy increases in adults compared with children (1,3,8). What is the basis of these age-dependent variations? What are the age-specific properties of the brain that contribute to the probability of seizure generation and to the nature of the resulting seizure?A second, reciprocal aspect of the interaction of the age of the brain and seizures involves the effects of a seizure on the structure and function of neurons and neuronal networks. Here, again, clinical evidence suggests that the consequences of a seizure might vary with age. For example, the consequences of status epilepticus (SE) in young children seem to depend on the inciting etiology (9, 10), and, in general, mortality and cognitive outcomes are more favorable than in the adult and elderly individual (11)(12)(13)(14). In contrast, status epilepticus in adult and aging individuals can have major detrimental effects on cognitive function and even survival (14-16). What is the basis of these age-dependent variations? What are the age-specific properties of the brain that modulate the effects of seizures on neuronal integrity and function?These questions are of paramount clinical importance because they should provide clues for developing age-specific diagnostic tools, prognostic models, and intervention strategies. Thus, while the answers to these questions are not fully elucidated, the questions provide a framework for discussing the salient elements of the evolving interaction between the brain and seizures throughout life.The following paragraphs highlight a few of the many facts that influence age-specific seizures and the age-specific consequences of seizures. Because most of the direct information about seizures throughout the life-span often derives from animal models, these are discussed. The author regrets that this overview is not comprehensive and likely omits a number of important publications. Nonetheless, this review serves to illustrate crucial features of the topic. Age-Specific Brain Properties Influence Seizures That Are Generated During Each AgeWhereas brain development from embryonic life to senescence is a continuum, here it is divided into four stages: the neonatal, childhood, adulthood, and aging epochs. The Neonatal Brain and Age-Specific Neonatal SeizuresThe neonatal brain is in a stage of rapid flux from both structural and functional perspectives. Neurons are still being born, circuits are being formed, and synapses are being established (17,18). Synaptic currents are often slower (19), neurotransmitters play trophic roles (20), and circuits are not fully mature (21). These facts predict that seizures may propag...

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“…[1][2][3] Thus, determination of etiology is critical, because it gives the opportunity to treat and to make a meaningful statement about the prognosis. [3][4][5] Nowadays, NS is defined by video -electroencephalographic monitoring, by clinical observation associated to ictal or interictal electroencephalogram (EEG), by electrographic discharge without associated clinical manifestation or by neonatal polysomnography 4,[6][7][8][9][10][11][12] . However, in clinical practice at the pediatric or neonatal intensive care units (ICU), in developing countries where synchronized video-EEG monitoring is practically nonexistent, clinical observation becomes the key to the diagnosis 3 .…”

Section: Introductionmentioning

confidence: 99%