Seizures

There is a number of different types of seizure activity in newborns.

Seizure types

• subtle seizures (grimace, blinking, yawning, salivation, cycling, apnea)
• myoclonus
• clonic seizures (unifocal, multifocal)
• tonic seizures (generalized hypertonia, decerebration-like posture, growling, apnea, bulbar deviation)

Etiology

• congenital CNS malformations
• hypoxic-ischemic encephalopathy (HIE)
• intracranial hemorrhage (intraventricular, subdural hemorrhage)
• meningitis, encephalitis
• medication
• hypoglycemia, hyponatremia, hypocalcemia
• bilirubin encephalopathy
• inherited metabolic disorders
• neonatal abstinence syndrome

Diagnosis

Clinical signs

• neurological examination (see neonatal examination)

Laboratory findings

• glycemia
• electrolytes (sodium, calcium, magnesium, potassium)
• inflammatory markers (CRP, procalcitonin, interleukin 6)
• cerebrospinal fluid

Imaging

• cranial ultrasound
• MRI of the brain
• EEG

Therapy

General

• ventilation and circulation stabilization (apneas)
• electrolyte and glycemia normalization

Specific

• anticonvulsants (anti-epileptic drugs)
• phenobarbitone (loading dose 20 mg/kg i.v. over 20-30 minutes, can be repeated)
• phenytoin
• midazolam

References

① Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizures. Semin Fetal Neonatal Med. 2013;18(4):185-191. doi:10.1016/j.siny.2013.05.008