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TAS Neonatal Medicine ✅ > Neonatal Seizures ✅ > Flashcards

Neonatal Seizures ✅ Flashcards

1
Q

How does the incidence of seizures in the neonatal period compare to at other times of life?

A

They are more common in neonatal period than any other time

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2
Q

What is the incidence of neonatal seizures in term babies?

A

1.5-3.5 per 1000 live births

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3
Q

What is the incidence of neonatal seizures in premature babies?

A

10-130 per 1000 live births

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4
Q

When do seizures occur, in terms of electrical activity in the brain?

A

When a large group of neurons undergo excessive, synchronised depolarisation

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5
Q

What can cause depolarisation of neurones?

A
  • Excessive excitatory amino acid release

- Deficient inhibitory neurotransmitter

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6
Q

Give an example of an excitatory amino acid that may be excessively released in seizures

A

Glutamate

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7
Q

Give an example of an inhibitory neurotransmitter that may be deficient in seizures

A

Gamma amino butyric acid (GABA)

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8
Q

What is the biochemical effect of neonatal seizures?

A

Derangements of energy metabolism

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9
Q

What do derangements in energy metabolism lead to in neonatal seizures?

A

Compromise of energy-dependent ion pumps and consequent rise of adenosine diphosphate (ADP) levels

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10
Q

What does the rise in ADP in neonatal seizures do?

A

Stimulates glycolysis, with the ultimate increase in pyruvate

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11
Q

What happens to pyruvate produced due to neonatal seizures?

A

It accumulates due to compromised mitochondrial function

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12
Q

What is the role of adenosine triphosphate (ATP)-dependent resting membrane potentials in seizures?

A

Seizures can be caused by disruption in ATP-dependent resting membrane potentials

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13
Q

What pump is important in ATP-dependent resting membrane potentials?

A

ATP-dependent sodium-potassium pump

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14
Q

What condition causes disruption of the ATP-dependent sodium-potassium pump?

A

Hypoxic-ischaemic encephalopathy

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15
Q

What is the effect of HIE on the ATP-dependent sodium-potassium pump?

A

It appears to cause excessive depolarisation leading to seizures

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16
Q

What is the function of the ATP-dependent sodium-potassium pump?

A

It allows sodium to flow into the neuronal and potassium to flow out of the neuron

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17
Q

How may seizures present in the neonatal period?

A
  • Clonic or tonic involuntary movements of one or more limbs
  • Apnoea, transient cyanosis, and episodes of oxygen desaturation
  • Lip smacking
  • Altered consciousness
  • Floppiness
18
Q

What is the problem with seizures in the developing brain?

A
  • Poorly classified
  • Frequently under-diagnosed
  • Difficult to treat
19
Q

What can the causes of neonatal seizures be classified into?

A
  • Cerebral
  • Metabolic
  • Infectious
  • Drugs
  • Other
20
Q

What are the cerebral causes of neonatal seizures?

A
  • Hypoxic-ischaemic
  • Subarachnoid or subdural haemorrhage
  • Parenchymal haemorrhage in preterm infants
  • Cerebral malformations of the brain, including vascular anomalies
21
Q

What are the hypoxic-ischaemic causes of neonatal seizures?

A
  • Hypoxic-ischaemic encephalopathy/birth trauma

- Focal ischaemia (arterial/venous)

22
Q

What are the metabolic causes of neonatal seizures?

A
  • Hypoglycaemia
  • Hypocalcaemia
  • Hypomagnesaemia
  • Hyponatraemia
  • Hypernatraemia
  • Inborn errors of metabolism
23
Q

What are the infectious causes of neonatal seizures?

A
  • Septicaemia
  • Meningitis
  • Encephalitis
24
Q

What are the drug causes of neonatal seizures?

A
  • Drug withdrawal

- Side-effect of drugs

25
Q

What are the other causes of neonatal seizures?

A
  • Kernicterus
  • Pyridoxine deficiency
  • Idiopathic benign neonatal seizures
26
Q

What is the most common cause of seizures in a term infant?

A

HIE

27
Q

What % of preterm infants with intraventricular haemorrhage or periventricular leukomalacia have seizures?

A

Up to 70%

28
Q

How can early recognition of neonatal seizures be assisted?

A

aEEG or EEG monitoring, preferably with video recording

29
Q

What investigations are done in neonatal seizures?

A
  • Comprehensive biochemical, infective, and metabolic screening
  • Neurophysiological studies
  • Imaging
30
Q

Give a neurophysiological study that may be done in the investigation of neonatal seizures

A

EEG

31
Q

What neuroimaging may be done in the investigation of neonatal seizures?

A
  • Cranial USS
  • CT
  • MRI
32
Q

What is the purpose of CT head in the investigation of neonatal seizures?

A

Identify haemorrhage or traumatic injury

33
Q

What is the purpose of MRI in the investigation of neonatal seizures?

A

Identify ischaemia or malformations

34
Q

What conditions may be screened for in the investigation of neonatal seizures?

A
  • Inborn errors of metabolism

- Congenital infection

35
Q

When are neonatal seizures treated?

A

If prolonged

36
Q

What anticonvulsant is best in neonatal seizure?

A

No anticonvulsant has been shown to be superior to others

37
Q

What is the limitation of anticonvulsant medications in neonatal seizures?

A

Evidence that some anticonvulsant medication, while reducing the abnormal movements, does not reduce the electrical discharge

38
Q

What is it called when there is a reduction in abnormal movements but not electrical discharge in seizures?

A

Electroclinical dissociation

39
Q

What is the prognosis of neonatal seizures?

A

Depends on cause

40
Q

What are neonatal seizures an independent risk factor for?

A

Adverse neurodevelopment outcome

TAS Neonatal Medicine ✅ (35 decks)

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