Global InformationNeonatal seizure information
| Neonatal seizure | |
|---|---|
| Other names | Seizures in neonates |
A neonatal seizure is a seizure in a baby younger than age 4-weeks that is identifiable by an electrical recording of the brain.[1] It is an occurrence of abnormal, paroxysmal, and persistent ictal rhythm with an amplitude of 2 microvolts in the electroencephalogram,.[2] These may be manifested in form of stiffening or jerking of limbs or trunk. Sometimes random eye movements, cycling movements of legs, tonic eyeball movements, and lip-smacking movements may be observed. Alteration in heart rate, blood pressure, respiration, salivation, pupillary dilation, and other associated paroxysmal changes in the autonomic nervous system of infants may be caused due to these seizures. Often these changes are observed along with the observance of other clinical symptoms.[3] A neonatal seizure may or may not be epileptic (due to a primary seizure disorder). Some of them may be provoked (i.e. due to a secondary cause). Most neonatal seizures are due to secondary causes.[4] With hypoxic ischemic encephalopathy being the most common cause in full term infants and intraventricular hemorrhage as the most common cause in preterm infants.[4]
According to the International League against Epilepsy (ILAE), seizures are defined as excessive or synchronous neuronal activity in the brain that is manifested as signs or symptoms. As per the classification system by the American Clinical Neurophysiology Society, seizures can be classified into electroclinical (clinical signs of a seizure and electrical brain monitoring signs of a seizure), clinical only, and electrographic-only seizures (signs of a seizure on electrical brain monitoring without clinical-visual signs of a seizure). Some infants, especially critically ill ones, may experience electrographic-only seizures.[5][6]
Neonatal seizures have been classified into various types. Neonates were found to experience either tonic or clonic seizures. If seizures were found to be focal, they were further classified into unifocal or multifocal.[7] Seizures in the neonatal population can be mainly categorized into acute symptomatic seizures and neonatal epilepsy that is related to genetic or structural factors.[8] Brain injury due to hypo-ischemic encephalopathy, ischemic stroke, intracranial hemorrhage or infection, inborn errors of metabolism, transient metabolic and brain malformations, lead to acute symptomatic seizures.[9] Neonatal epilepsy may be credited to genetic syndromes, developmental structural brain abnormalities, or metabolic diseases.[10]
The incidence of seizures is more common in the neonatal stage than in other stages of life.[11] Neonatal seizures are comparatively rare and affect 1 or 3.5 in 1000 infants born.[12] They are the most frequent neurological problem in the nursery that is associated with greater risks of morbidity and mortality,[13][14] often requiring evaluation and treatment in a neonatal intensive care unit. Better care delivered in neonatal care units, with improved healthcare facilities, has decreased the mortality rate associated with these seizures. However, the long-term morbidity rate remains approximately the same.[15]
Neonatal seizures are generally subclinical and their diagnosis based on the clinical observations is generally difficult.[16][17] Diagnosis relies on identification of the cause of the seizure, and verification of actual seizure activity by measuring electrical activity with electroencephalography (EEG). The set of guidelines developed by the American Clinical Neurophysiology Society helps the healthcare providers know when the EEG is appropriate and corresponds to the seizures.[18] Treatment depends generally on the underlying cause of the seizure if it is provoked. anti-epileptic drugs are also administered.
Neonatal seizures that are provoked (due to a secondary cause) usually resolve in the neonatal period when the secondary cause is treated. Neonates with epilepsy syndromes often have seizures later in life.[4] It has been estimated that approximately 15% of neonatal seizures represent epilepsy syndrome.[19] The incidence of seizures is higher in the neonatal period than at any other time of life,[20] and most often occurs in the first week of life.[21]
- ^ Garfinkle, Jarred; Miller, Stephen P. (2022). "110. Neonatal seizures". In Jankovic, Joseph; Mazziotta, John C.; Pomeroy, Scott L. (eds.). Bradley and Daroff's Neurology in Clinical Practice. Vol. II. Neurological disorders and their management (8th ed.). Edinburgh: Elsevier. pp. 2022–2039. ISBN 978-0-323-64261-3.
- ^ Shellhaas, Renée A.; Chang, Taeun; Tsuchida, Tammy; Scher, Mark S.; Riviello, James J.; Abend, Nicholas S.; Nguyen, Sylvie; Wusthoff, Courtney J.; Clancy, Robert R. (December 2011). "The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates". Journal of Clinical Neurophysiology. 28 (6): 611–617. doi:10.1097/WNP.0b013e31823e96d7. ISSN 0736-0258. PMID 22146359.
- ^ Blaise F. Bourgeois; Edwin Dodson; Douglas R. Nordli Jr; John M. Pellock; Raman Sankar (2007-12-16). Pediatric Epilepsy: Diagnosis and Therapy. Demos Medical Publishing. ISBN 978-1-934559-86-4.
- ^ a b c Cite error: The named reference
Yozawitz 2023was invoked but never defined (see the help page). - ^ Mizrahi, E. M.; Kellaway, P. (1987-12-01). "Characterization and classification of neonatal seizures". Neurology. 37 (12): 1837–1844. doi:10.1212/wnl.37.12.1837. ISSN 0028-3878. PMID 3683874. S2CID 30323179.
- ^ Tsuchida, Tammy N.; Wusthoff, Courtney J.; Shellhaas, Renée A.; Abend, Nicholas S.; Hahn, Cecil D.; Sullivan, Joseph E.; Nguyen, Sylvie; Weinstein, Steven; Scher, Mark S.; Riviello, James J.; Clancy, Robert R. (April 2013). "American Clinical Neurophysiology Society Standardized EEG Terminology and Categorization for the Description of Continuous EEG Monitoring in Neonates". Journal of Clinical Neurophysiology. 30 (2): 161–173. doi:10.1097/wnp.0b013e3182872b24. ISSN 0736-0258. PMID 23545767. S2CID 6381050.
- ^ Rose, Arthur L.; Lombroso, Cesare T. (1970-03-01). "NEONATAL SEIZURE STATES: A Study of Clinical, Pathological, and Electroencephalographic Features in 137 Full-term Babies with a Long-term Follow-up". Pediatrics. 45 (3): 404–425. doi:10.1542/peds.45.3.404. ISSN 0031-4005. S2CID 245089207.
- ^ "Recent Advances in the Diagnosis and Treatment of Neonatal Seizures - Yahoo Search Results". search.yahoo.com. Retrieved 2022-01-30.
- ^ Beleza, Pedro (May 2012). "Acute symptomatic seizures: a clinically oriented review". The Neurologist. 18 (3): 109–119. doi:10.1097/NRL.0b013e318251e6c3. ISSN 2331-2637. PMID 22549348. S2CID 25710798.
- ^ Axeen, Erika J. T.; Olson, Heather E. (2018-06-01). "Neonatal epilepsy genetics". Seminars in Fetal and Neonatal Medicine. NEONATAL SEIZURE. 23 (3): 197–203. doi:10.1016/j.siny.2018.01.003. ISSN 1744-165X. PMID 29426807. S2CID 46818810.
- ^ Volpe, Joseph J. (2008-06-11). Neurology of the Newborn E-Book. Elsevier Health Sciences. ISBN 978-1-4377-2079-2.
- ^ Vasudevan, Chakrapani; Levene, Malcolm (August 2013). "Epidemiology and aetiology of neonatal seizures". Seminars in Fetal and Neonatal Medicine. 18 (4): 185–191. doi:10.1016/j.siny.2013.05.008. ISSN 1744-165X. PMID 23746578.
- ^ Pisani, Francesco; Cerminara, Caterina; Fusco, Carlo; Sisti, Lisa (2007-12-04). "Neonatal status epilepticus vs recurrent neonatal seizures: Clinical findings and outcome". Neurology. 69 (23): 2177–2185. doi:10.1212/01.wnl.0000295674.34193.9e. ISSN 0028-3878. PMID 18056582. S2CID 39133720.
- ^ Pisani, Francesco; Barilli, Angela Luciana; Sisti, Lisa; Bevilacqua, Giulio; Seri, Stefano (2008-01-01). "Preterm infants with video-EEG confirmed seizures: Outcome at 30 months of age". Brain and Development. 30 (1): 20–30. doi:10.1016/j.braindev.2007.05.003. ISSN 0387-7604. PMID 17964748. S2CID 25487534.
- ^ Ramantani, Georgia (December 2013). "Neonatal epilepsy and underlying aetiology: to what extent do seizures and EEG abnormalities influence outcome?". Epileptic Disorders. 15 (4): 365–375. doi:10.1684/epd.2013.0619. ISSN 1294-9361. PMID 24342861. S2CID 22568118.
- ^ Glass, Hannah C.; Wusthoff, Courtney J.; Shellhaas, Renée A.; Tsuchida, Tammy N.; Bonifacio, Sonia Lomeli; Cordeiro, Malaika; Sullivan, Joseph; Abend, Nicholas S.; Chang, Taeun (2014-04-08). "Risk factors for EEG seizures in neonates treated with hypothermia: a multicenter cohort study". Neurology. 82 (14): 1239–1244. doi:10.1212/WNL.0000000000000282. ISSN 1526-632X. PMC 4001204. PMID 24610326.
- ^ Clancy, Robert R.; Legido, Agustin; Lewis, Donald (1988). "Occult Neonatal Seizures". Epilepsia. 29 (3): 256–261. doi:10.1111/j.1528-1157.1988.tb03715.x. ISSN 1528-1167. PMID 3371282. S2CID 24190612.
- ^ Shellhaas, Renée A.; Chang, Taeun; Tsuchida, Tammy; Scher, Mark S.; Riviello, James J.; Abend, Nicholas S.; Nguyen, Sylvie; Wusthoff, Courtney J.; Clancy, Robert R. (December 2011). "The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates". Journal of Clinical Neurophysiology. 28 (6): 611–617. doi:10.1097/WNP.0b013e31823e96d7. ISSN 0736-0258. PMID 22146359.
- ^ Shellhaas RA, Wusthoff CJ, Tsuchida TN, Glass HC, Chu CJ, Massey SL, Soul JS, Wiwattanadittakun N, Abend NS, Cilio MR (August 2017). "Profile of neonatal epilepsies: Characteristics of a prospective US cohort". Neurology. 89 (9): 893–899. doi:10.1212/WNL.0000000000004284. PMC 5577964. PMID 28733343.
- ^ Sheth RD, Hobbs GR, Mullett M (January 1999). "Neonatal seizures: incidence, onset, and etiology by gestational age". Journal of Perinatology. 19 (1): 40–3. doi:10.1038/sj.jp.7200107. PMID 10685200.
- ^ Plu, Fred (1983). "Status epilepticus. Mechanisms of brain damage and treatment". Annals of Neurology. 34 (6): 1–551. doi:10.1002/ana.410150628. PMID 6829325.