Neonatal Epileptic Syndromes Flashcards
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Demography
High in preterm infants. Up to 10%.
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Demography
Rare.
Neonatal Epileptic Syndromes
Benign neonatal seizures - Demography
7% of all neonatal seizures
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Demography
Rare. Boys and Girls are equally effective.
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Demography
Rare. Slight male predominance.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Age range of onset
80% occur in the first 1 or 2 days during the first week of life.
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Age range of onset
Seizures mainly on the second or third day of life
Neonatal Epileptic Syndromes
Benign neonatal seizures - Age range of onset
Usually between days four and six. This syndrome is synonym with fifth day fits. Boys are affected slightly more than girls
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Age range of onset
Usually starts in the first days of life; sometimes immediately after birth. Majority starts before 10 days of age.
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Age range of onset
Onset is mainly around the first 10 days of life; sometimes within the uterus or up to three months after birth.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Semiology
Usually subtle; and difficult to recognize from normal behavior patterns. Seizures are brief and repetitive. Frequent autonomic manifestations such as changing heart rate or respiratory rate
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Semiology
Occur in otherwise normal neonates. Seizures are brief – 1-2 min; 20-30/day. Usually start with tonic motor activity; posturing and apnea
Neonatal Epileptic Syndromes
Benign neonatal seizures - Semiology
Repetitive lengthy seizure that constitutes a clonic status epilepticus which occurs in a otherwise normal full-term neonate. The median time is about 20 hours. Tonic seizures are incompatible with this syndrome
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Semiology
Triad of intractable seizures: myoclonus; followed by simple focal seizures; followed later by tonic epileptic spasms. Erratic (shifting from one part of the body to another in the random fashion) myoclonus that are nearly continuous and may affect a finger; corner of the mouth; toe; etc.
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Semiology
Electrical clinical manifestations of tonic spasms and burst suppression patterns during sleep and waking states. Tonic seizures are brief and occur in clusters that can repeat several times a day. Some patients may have focal motor clonic seizures. Myoclonic seizures are rare.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Etiology
Several possibilities. Hypoxic ischemic encephalopathy accounts for 80% of cases
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Etiology
Autosomal dominant channelopathy with high degree of penetrance. Mutations in the voltage gated potassium channel subunit genes KCNQ2 or KCNQ3. Both form a potassium channel that determines the M – current. Note – mutations in the sodium channel SCN2A are specific to benign familial neonatal – infantile seizures
Neonatal Epileptic Syndromes
Benign neonatal seizures - Etiology
Unknown. Zinc deficiency has been postulated
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Etiology
Multi-factorial disease. Inborn errors of metabolism are the most common causes: non-ketotic hyperglycinemia; propionic aciduria; methylmalonic acidemia; glyceric acidemia; xanthine oxidase deficiency; menkes dz; Zellweger sd.; molybdenium cofactor deficiency.
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Etiology
Malformations of cortical development. Examples are hemimegalencephaly; focal dysplasias; Aicardi syndrome; agenesis of mammillary bodies; olivary dentate dysplasia. There are no familial cases. This syndrome is likely to be the earliest age-related specific epileptic reaction of the developing brain to heterogeneous insults
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Genetic testing or metabolic screening
None
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Genetic testing or metabolic screening
Can be performed; but expensive and not routinely available
Neonatal Epileptic Syndromes
Benign neonatal seizures - Genetic testing or metabolic screening
None
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Genetic testing or metabolic screening
Thorough metabolic screening is mandatory; including serum levels of amino and organic acids and amino acids in the CSF
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Genetic testing or metabolic screening
Metabolic screening is mandatory imaging is normal.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Imaging
Variable
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Imaging
Normal
Neonatal Epileptic Syndromes
Benign neonatal seizures - Imaging
Normal
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Imaging
Normal at onset; with brain atrophy as the disease progresses.
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Imaging
Usually shows severe abnormalities.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Interictal EEG
Spikes are not reliable at this age. Other patterns such as burst suppression; hemispheric asymmetry; or theta – pointu alternans are more helpful
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Interictal EEG
Normal or with discontinuity and multifocal abnormalities; including theta-pointu alternans
Neonatal Epileptic Syndromes
Benign neonatal seizures - Interictal EEG
Normal or with discontinuity and multifocal abnormalities; including theta-pointu alternans
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Interictal EEG
Repetitive burst suppression pattern without physiological rhythms. The bursts are short and the suppression is long. Later; a hypsarhythmic pattern may appear; but it is replaced again by burst suppression.
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Interictal EEG
Burst suppression pattern with long bursts (with high amplitude slow waves mixed with spikes) and short suppressions.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Ictal EEG
Repetitive patterns (multiple frequencies). Usually associated with tonic; clonic or subtle seizures. More commonly on Central temporal; central and occipital regions. Only 21% are associated with clinical manifestations (electro clinical dissociation)
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Ictal EEG
Synchronous and bilateral flattening coinciding with clinical symptoms followed by asymmetrical discharges off epileptiform patterns
Neonatal Epileptic Syndromes
Benign neonatal seizures - Ictal EEG
Rhythmic spikes or slow waves mainly in the rolandic regions (but may also occur elsewhere)
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Ictal EEG
The myoclonia do not have an ictal EEG expression and may follow bursts
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Ictal EEG
The tonic spasms are concomitant with the burst phase. The ictal pattern may also occur as a diffuse desynchronization or with a more frequent burst suppression pattern. Hypssarhythmia emerges after 3-6 months; later progressing to the slow spike wave pattern. Tonic seizures during the awake and sleep stages in the early days or weeks of life are almost pathognomonic of Ohtahara syndrome.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Differential diagnosis
As a rule; any suspicious behavior should be investigated by video EEG.
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Differential diagnosis
A family history of similar seizures is a prerequisite for the diagnosis
Neonatal Epileptic Syndromes
Benign neonatal seizures - Differential diagnosis
This diagnosis can be made only after other causes of neonatal seizures have been excluded
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Differential diagnosis
Ohtahara syndrome
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Differential diagnosis
Early myoclonic encephalopathy
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Prognosis
Depends on the underlying cause.
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Prognosis
Seizures usually remit in the first six weeks to six months. 10 to 14% may later develop other types of seizures. Normal psychomotor development.
Neonatal Epileptic Syndromes
Benign neonatal seizures - Prognosis
Normal development and no recurrence of seizures
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Prognosis
Psychomotor developmental abnormalities may occur at the onset of seizures or deteriorate rapidly afterwards. There is hypotonia and hypertonia; deconjugate eye movements and decerebrate posturing with pyramidal signs. Usually patients aren’t able to follow objects with their eyes. Dreadful prognosis; with more than half of the patients dying within weeks or months of onset.
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Prognosis
Devastating syndrome with high mortality and mobility.
Neonatal Epileptic Syndromes
Neonatal epileptic seizures - Management
Treatment of the underlying cause. Pharmacological treatment is controversial among specialists. Phenobarbita and phenytoin are the most commonly used drugs.
Neonatal Epileptic Syndromes
Benign familial neonatal seizures - Management
There is no consensus. The use of AED does not influence outcome
Neonatal Epileptic Syndromes
Benign neonatal seizures - Management
Convulsions remit spontaneously without medication
Neonatal Epileptic Syndromes
Early myoclonic encephalopathy - Management
There is no effective treatment. ACTH or antiepileptic drugs are of no benefit. A trial with pyridoxine is justifiable
Neonatal Epileptic Syndromes
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Management
There is no effective treatment. ACTH or antiepileptic drugs are of no benefit.