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

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

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