Neonatal Flashcards
order of EEG maturational changes in neonate
Active sleep > awake > quiet sleep
Synchrony by age:
A)
B)
C)
Abnormal finding:
Synchrony by age:
A) - <28 weeks = no asynchrony
B) - 28-32 weeks; 70% syncrony
C) > 37 weeks: mostly synchronus
Abnormal finding: Asyhcrony of >1.5 s
% of patients with normal development in:
HIE:
IVH:
SAH:
Infections:
Cerebral malformations:
metabolic disorders:
% of patients with normal development in:
HIE: 50%
IVH: 10%
SAH: 90%
Infections: 50%
Cerebral malformations: 0%
metabolic disorders: Transient: 50-100%
Neonatal seizure likelihood:
Focal and multifocal CLONIC:
Focal and generalized TONIC:
Myoclonic:
Subtle seizure pattern:
name 7 subtle seizure patterns:
Neonatal seizure likelihood:
Focal and multifocal CLONIC: 25%
Focal and generalized TONIC: 5%
Myoclonic: 20%
Subtle seizure pattern: 50%
name 7 subtle seizure patterns:
- Apnea
- Tonic deviation of the eyes
- Eyelid fluttering
- Drooling, sucking, chewing
- swimming movements of the arm
- pedaling movements of the legs
- paroxysmal laughing
Pyridoxine dependent epilepsy:
age of presentation (name two)
Pyridoxine dependent epilepsy:
age of presentation (name two)
- neontatal: Shortly after birth
- Atypical: 1 and 3 years
Pyridoxine Dependent epilepsy:
Testing:
Lab #1 (+ 2 locations)
Lab #2 (+ 2 locations)
Gene
- elevated alpha-aminoadipic semialdehyide (a-AASA) in urine / plasma
- elevated pipecolic acid in Plasma and CSF
- Mutation in ALDH7A1
Pyridoxine dependent epilepsy:
Treatment (+ Dose)
Folinic acid at 4 mg/kg/day divided BID
Voltage ranges for Trace discontinue
High amplitude bursts: 50-300 uV
“quiescence” (<25 uV)
Inter-burst intervals:
- duration associated with higher SURVIVAL in 30+weeks:
8 Seconds or less
conceptual age in which you begin seeing varation
35 weeks
In neonates, where are you most likely to see abnormalities (and why?)
Quiet sleep (last stage to see maturational changes)
Normal vs Abnormal Sharp transients in neonatal EEG
- Location
- morphology
- polarity
- amplitude
- duration
- In what stage?
Normal vs Abnormal Sharp transients in neonatal EEG
- Location
- Normal: Bitemporal / central
- Abnormal: one persistent location
- morphology
- Normal: monophasic / Diphasic
- Abnormal: variable / polyphasic
- polarity
- normal: negative
- abnormal: negative OR positive
- amplitude
- Norma: <75 uV
- Abnormal: >150 uV
- duration
- Normal: <100 ms
- >150 ms
- In what stage?
- Normal: quiet sleep
- Abnormal: awake and quiet sleep
Trace Alternans
- When do you typically see it?
- When is it ABNORMAL to see it?
- what replaces this pattern?
Trace Alternans
- When do you typically see it? 35w-42w
- When is it ABNORMAL to see it? 42+ weeks
- what replaces this pattern? medium-t-high voltage delta slow during sleep
Benign myoclonic epilepsy of infancy (BMEI)
Sex:
Treatment of choice:
Family history can be positive for…
Benign myoclonic epilepsy of infancy (BMEI)
Sex: males > females
Treatment of choice: Valproate
Family history can be positive for febrile seizures or epilepsy
Factor favored to explain why neonatal seizures are difficult to treat
Excitatory nature of GABA signaling (why Gaba agonists are often inneffective)
