Neonatal Seizures

Posted by e-Medical PPT Thursday, March 1, 2012
Tonic Seizures—focal or generalized, may mimic decorticate or decerebrate posturing, primarily seen in preterms with intracranial hemorrhage and generally have poor prognosis

Subtle seizures
Consist of chewing motion, excessive salivation and alteration in respiratory rate including apnea, blinking, nystagmus, bicycling and pedaling movements, changes in color

Clonic- focal (repetitive movements localized to a single limb) or multifocal (random migration of movements from limb to limb), consciousness may be preserved, primarily seen in term infants.

Myoclonic- sudden flexor movements (lightning-like jerks), may be focal, multifocal or generalized, may occuring singly or in clusters, if due to early myoclonic encephalopathy it carries a poor prognosis. Brief focal or generalized jerks of the extremities or body that tend to involve distal muscle groups

Neonatal Seizures_EEG Classification
Clinical seizure with consistent EEG event
 Clinical seizure occurs in relationship to seizure activity
 Includes focal clonic, focal tonic and myoclonic
 Responds to antiepileptic drugs
Clinical seizure with inconsistent EEG event
 Clinical seizures with no EEG abnormality
 Seen in all generalized tonic and subtle seizures
 Seen in patients who are comatose, HIE
Electrical seizures with absent clinical seizures
 Electrical seizures associated with markedly abnormal background EEG
 Seen in comatose patients

Idiopathic Syndromes of Clinical Seizures in the Newborn
Epileptic Syndromes
Benign familial Neonatal Seizures
Benign idiopathic neonatal seizures (fifth-day fits)
Early myoclonic encephalopathy
Early infantile epileptic encephalopathy (Ohtahara syndrome)
Malignant migrating partial seizures
Nonepileptic Syndromes
Benign neonatal sleep myoclonus

Conditions that Mimic Seizures
Night terrors
Common in boys
5 – 7 years of age
Sudden onset between midnight and 2:00 am during stage 3 or 4 of sleep or slow-wave sleep
Child screams and appears frightened, dilated pupils, tachycardia and hyperventilation
Child thrash violently can not be consoled , unaware of parents or surroundings
1/3 will have somnambulism
Emotional disorder should be explored in patient with prolonged and persistent night terrors
Short course diazepam maybe considered while the family dynamics is investigated

Breath holding spells
Cyanotic spells
 Provoked by upsetting or scolding an infant
 Brief shrill cry followed by forced expiration and apnea
 Rapid onset of generalized cyanosis or loss of consciousness may be associated with repeated generalized tonic jerks,  opisthotonos, bradycardia
 EEG: normal
 Rare before 6 months, peak about 2 years & abate by 5 years old
 TX: parent counseling

Pallid spells
 Initiated by painful experience
 Child stops breathing  loss of consciousness  pale and hypotonic  tonic seizures
 Bradycardia with asystole for 2 seconds may be recorded
 EEG: normal
 TX supportive but may give atrophine sulfate at 0.01 mg/kg/24 hr in divided doses with a maximum dose of 0.4 mg

 Simple syncope
 Decreased blood flow  loss of consciousness  ischemia influences the higher cortical centers to release inhibiting  influence on reticular formation within the brainstem  brief tonic contractions of muscles
 Results from vasovagal stimulation precipitated by pain, fear, excitement , prolonged standing particularly in a warm  environment
 Age : 10 -12 years old, females..

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