Abstract
Neonatal seizures occur in their majority in close temporal relation to an acute brain injury or systemic insult, and are accordingly defined as acute symptomatic or provoked seizures. However less frequently, unprovoked seizures may also present in the neonatal period as secondary to structural brain abnormalities, thus corresponding to structural epilepsies, or to genetic conditions, thus corresponding to genetic epilepsies. Unprovoked neonatal seizures should be thus considered as the clinical manifestation of early onset structural or genetic epilepsies that often have the characteristics of early onset epileptic encephalopathies. In this review, we address the conundrum of neonatal seizures including acute symptomatic, remote symptomatic, provoked, and unprovoked seizures, evolving to post-neonatal epilepsies, and neonatal onset epilepsies. The different clinical scenarios involving neonatal seizures, each with their distinct post-neonatal evolution are presented. The structural and functional impact of neonatal seizures on brain development and the concept of secondary epileptogenesis, with or without a following latent period after the acute seizures, are addressed. Finally, we underline the need for an early differential diagnosis between an acute symptomatic seizure and an unprovoked seizure, since it is associated with fundamental differences in clinical evolution. These are crucial aspects for neonatal management, counselling and prognostication. In view of the above aspects, we provide an outlook on future strategies and potential lines of research in this field.
Highlights
Seizures are the most frequent neurological sign observed in the neonatal intensive care unit and occur in their majority in close temporal relation to an acute brain injury or systemic insult, with or without identifiable structural abnormalities [1]
These events are defined as acute symptomatic or provoked seizures. These two terms are often used interchangeably, acute symptomatic seizures are defined as resulting from an acute brain injury, such as stroke, trauma or brain infection, whereas provoked seizures are defined as resulting from transient and reversible brain alterations of metabolic or toxic origin [2]
These are defined as seizures occurring in the absence of a potentially causative clinical condition or beyond the in terval estimated for the occurrence of acute symptomatic seizures [4]
Summary
Seizures are the most frequent neurological sign observed in the neonatal intensive care unit and occur in their majority in close temporal relation to an acute brain injury or systemic insult, with or without identifiable structural abnormalities [1]. These events are defined as acute symptomatic or provoked seizures. Though less frequently, unprovoked seizures may present in the neonatal period [3] These are defined as seizures occurring in the absence of a potentially causative clinical condition or beyond the in terval estimated for the occurrence of acute symptomatic seizures [4].
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