Neonatal Seizures Flashcards
How is a seizure defined?
A seizure is defined as an abnormal synchronous electrical discharge of a group of neurons in the central nervous system (CNS) lasting at least 10 seconds.
What clinical manifestations are typically associated with a seizure?
A seizure is usually accompanied by abnormal levels of consciousness, abnormal movement, or autonomic abnormalities.
Why are clinical manifestations of seizures often subtle or absent in newborn infants?
In newborn infants, clinical manifestations of seizures are often subtle or absent due to the immature central nervous system.
What are some subtle manifestations of seizures in newborn infants?
Subtle manifestations of seizures in newborn infants include eye deviation, eyelid fluttering, and bucco-lingual movements.
How might complex repetitive movements, such as pedaling of arms and legs, be interpreted in newborn infants?
Complex repetitive movements such as pedaling of arms and legs may represent seizure activity or disinhibited brainstem activity.
What are some examples of seizure activity that newborn infants may present with?
Newborn infants may present with clonic focal or multifocal rhythmic twitching, generalized posturing, or myoclonic twitching.
How can increased jitteriness be distinguished from convulsions in newborn infants?
Unlike jitteriness, convulsions cannot be induced or stopped by handling the infant.
What is the most common cause of neonatal seizures in the first few days of life?
Intrauterine hypoxia-ischemia causing abnormal cellular metabolism and/or infarction is the most common cause of neonatal seizures in the first few days of life.
Besides intrauterine hypoxia-ischemia, what are other important causes of neonatal seizures?
Other important causes of neonatal seizures include biochemical abnormalities such as
-hypoglycemia,
-hypocalcemia,
-hypomagnesemia,
-hypernatremia, and
-hyponatremia;
-cerebral hemorrhage/thrombosis;
-brain malformations;
-meningitis or encephalitis;
-bilirubin encephalopathy;
-drug withdrawal after maternal opiate abuse; and
-neonatal onset epilepsy syndromes
Pertinent history includes
family history,
maternal medical history;
drug/alcohol use;
antenatal, labour and
birth complications; and
clinical course since birth.
What are the most urgent serum investigations to be performed in a neonate with seizures?
Serum glucose, magnesium, calcium and sodium are the most urgent as they are
the easiest to treat
In cases where the cause of neonatal seizures is not immediately apparent, what additional investigations might be necessary?
- Lumbar puncture and blood culture if causes other than sepsis are not obvious –
antibiotics should be commenced if these investigations are done. - Confirm seizures on EEG or amplitude intergrated EEG (continual single or dual
channel EEG monitoring with a cerebral function monitor) if available. - Head ultrasound may be diagnostic if intracranial bleeding, structural
abnormality or ventriculitis are present. - If the cause is not clear and/or seizures do not respond to treatment, investigate
for inborn errors of metabolism (serum lactate, ammonia, amino acids and urine
organic acids)
What is the purpose of performing a lumbar puncture in a neonate with seizures?
A lumbar puncture is performed to obtain cerebrospinal fluid for analysis, which can help diagnose or rule out infectious causes such as meningitis or encephalitis.
How can confirmatory tests like EEG or amplitude-integrated EEG monitoring aid in the diagnosis of neonatal seizures?
EEG or amplitude-integrated EEG monitoring can help confirm the presence of seizures by detecting abnormal electrical activity in the brain.
What conditions might be identified through head ultrasound in neonates with seizures?
Head ultrasound may reveal intracranial bleeding, structural abnormalities, or ventriculitis, which could be contributing factors to the neonatal seizures.
What initial steps should be taken in the treatment of neonatal seizures?
Resuscitation measures should be initiated, including airway management to ensure adequate ventilation and establishing intravenous access to optimize hydration and perfusion
Why is it important to address the underlying cause of neonatal seizures urgently?
Addressing electrolyte/glucose abnormalities or suspected sepsis promptly is crucial to effectively manage neonatal seizures and prevent further complications.
When should treatment be initiated for neonatal seizures?
Treatment should be initiated for seizures lasting more than 3 minutes, recurrent seizures, or any seizure causing cardio-respiratory compromise.
What is the first-line anticonvulsant treatment for neonatal seizures?
The first-line anticonvulsant treatment for neonatal seizures is Phenobarbitone.
What is the second-line anticonvulsant treatment if seizures persist?
Midazolam is the second-line anticonvulsant treatment for neonatal seizures.
What is the third-line treatment option for intractable neonatal seizures?
Pyridoxine is the third-line treatment option for intractable neonatal seizures.
In what situation may lignocaine infusion be considered in neonatal seizure treatment?
Lignocaine infusion may be used in an intensive care setting if phenytoin has not been effective. Care must be taken to use lignocaine suitable for intravenous use
What are alternative agents to lignocaine for treating neonatal seizures?
Alternative agents to lignocaine include levetiracetam, lorazepam, or clonazepam.
