Cause Of Neonatal Seizures Research Articles

Etiology and type of neonatal seizures

Background: Neonatal seizure is the most common disorder in neonate and the etiology varies among neonates. Materials and Methods: In total of 100 neonates less than 28 days with seizures are take into consideration and compared. Results: Among the 100 neonates Hypoxic Ischemic Encephalopathy was the most common cause followed by sepsis and metabolic causes. Subtle Seizures was the most common type followed by clonic and focal and myoclonic seizures. Discussion: The initial evaluation based on examination and etiology of seizures is important for pediatrician to assess for the treatment given. Conclusion: HIE is the most common cause of neonatal seizures. Subtle seizures are the most common type of neonatal seizures.

Provision of Sedation and Treatment of Seizures During Neonatal Therapeutic Hypothermia.

Hypoxic-ischemic encephalopathy (HIE) produces a high rate of long-term neurodevelopmental disability in survivors. Therapeutic hypothermia dramatically improves the incidence of intact survival, but does not eliminate adverse outcomes. The ideal provision of sedation and treatment of seizures during therapeutic hypothermia represent therapeutic targets requiring optimization in practice. Physiologic stress from therapeutic hypothermia may obviate some of the benefits of this therapy. Morphine is commonly utilized to provide comfort, despite limited empiric evidence supporting safety and efficacy. Dexmedetomidine represents an interesting alternative, with preclinical data suggesting direct efficacy against shivering during induced hypothermia and neuroprotection in the setting of HIE. Pharmacokinetic properties must be considered when utilizing either agent, with safety dependent on conservative dosing and careful monitoring. HIE is the leading cause of neonatal seizures. Traditional therapies, including phenobarbital, fosphenytoin, and benzodiazepines, control seizures in the vast majority of neonates. Concerns about the acute and long-term effects of these agents have led to the exploration of alternative anticonvulsants, including levetiracetam. Unfortunately, levetiracetam is inferior to phenobarbital as first-line therapy for neonatal seizures. Considering both the benefits and risks of traditional anticonvulsant agents, treatment should be limited to the shortest duration indicated, with maintenance therapy reserved for neonates at high risk for recurrent seizures.

Continuous Video Electroencephalogram during Hypoxia-Ischemia in Neonatal Mice.

Hypoxia ischemia is the most common cause of neonatal seizures. Animal models are crucial for understanding the mechanisms and physiology underlying neonatal seizures and hypoxia ischemia. This manuscript describes a method for continuous video electroencephalogram (EEG) monitoring in neonatal mice to detect seizures and analyze EEG background during hypoxia ischemia. Use of video and EEG in conjunction allows description of seizure semiology and confirmation of seizures. This method also allows analysis of power spectrograms and EEG background pattern trends over the experimental time period. In this hypoxia ischemia model, the method allows EEG recording prior to injury to obtain a normative baseline and during injury and recovery. Total monitoring time is limited by the inability to separate pups from the mother for longer than four hours. Although, we have used a model of hypoxic-ischemic seizures in this manuscript, this method for neonatal video EEG monitoring could be applied to diverse disease and seizure models in rodents.

Study of breakthrough seizures in newborns with hypoxic-ischemic encephalopathy after stopping anticonvulsant therapy

Background: Neonatal seizure is a distinct clinical response to neurological dysfunction. Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal seizures. Neonates with seizures are at risk of neurodevelopmental impairment, cognitive, behavioral disorders, epilepsy in later part of life, and even death during the neonatal period of life. Objective: The objective of the study was to study the occurrence of breakthrough seizures in a newborn with HIE after stopping anticonvulsant therapy. Materials and Methods: The study was a prospective cross-sectional study done in a Level III NICU of a tertiary hospital in Western India. A total of 35 full-term newborns with evidence of perinatal hypoxia with HIE II, III as per Sarnat and Sarnat staging and magnetic resonance imaging were enrolled. Patients with seizures were treated with intravenous phenobarbitone (PB). Patients were observed for breakthrough seizures after discontinuation of PB and were followed up at high-risk outpatient department until 6 months of age. Results: A total of 31 (88.6%) cases of 35 did not manifest breakthrough seizures. There were four (11.4%) cases which manifested breakthrough seizure after stopping anticonvulsant therapy and three had HIE III (p=0.044). Maternal anemia was observed to have a statistically significant association with breakthrough seizures (p<0.0001). There were nine cases with an abnormal neurological examination, three manifested breakthrough seizures, and there was no statistical correlation between neurological examination and occurrence of clinical and breakthrough seizures (p=0.0165). Conclusion: After initial seizure control by anticonvulsant therapy, breakthrough seizures are not increased after withholding the maintenance therapy.

Clinico-aetiological profile and outcome patterns of neonatal seizures at a tertiary care centre

Background: Neonatal seizures are a major risk factor for neonatal mortality and subsequent neurological disability. The incidence of seizure varies from 1.5-3.7/1000 live birth; while in NICU it can be up to 5/1000 live birth.Methods: This Descriptive type of observational study aimed to study clinical profile, aetiology in neonatal seizures and short term outcome was done in all Neonatal units attached to paediatric Department of SMS Medical College, Jaipur.Results: In the 100 cases Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Most common type of neonatal seizure was subtle(75%), other types were tonic seizure (17.3%), clonic seizure (5.1%) and least common type was myoclonic (2.5%). Most common cause of neonates seizure noted was birth asphyxia (73%) second common cause is pyomeningitis and third common cause is hypoglycaemia. Most common cause of neonatal seizure both in full term (71.17%) and preterm (25%) is birth asphyxia. Second most common cause of neonatal seizure in full term is pyomeningitis (8.70%) and in preterm is pyomeningitis and hypoglycaemia (25%). Most common cause of neonatal seizure both in onset of seizure <3 days (<72 hours) 53% and in onset of seizure >3 days (>72 hours).Conclusions: Out of total 100 cases, neonates with normal birth weight 92% and low birth weight 8%. Majority of neonates had onset of seizure <3 days (<72 hours) 53% and remaining 47% neonates had onset of seizure >3 days (>72 hours). Majority of neonates with seizure delivered by vaginal route (86%) and remaining 14% neonates were delivered by LSCS.

Clinico-Biochemical Abnormalities in Hospitalized Neonates with or without Seizure

Introduction: To determine the clinical types and etiological factors and to assess the biochemical abnormalities in neonates with seizure.
 Materials and Methods: This was a Cross-sectional, comparative hospital based study. Ninety neonates, age up to 28 days of both sexes were evaluated for clinical types, etiological factors and biochemical abnormalities with seizure and compared with those having no seizures. The variables were analyzed using student t- test. All the data was processed and analyzed by computer software SPSS version 15.0. Level of significance was considered as p value less than 0.05.
 Results: Most of the neonates having seizures (72%) within 3 days of life. The seizures were common in male babies (62%). 35% of the mother of baby with seizure gave history of prolonged labour. HIE was diagnosed 56.67% neonates with seizure whereas infection were found in 25% cases with seizure. Among the seizure subtypes, subtle seizures were 58% followed by clonic seizures 30%. Significant biochemical changes we found in 43.34% of neonates with seizures. Hypocalcemia (46%) was most common followed by hypoglycemia(38%).
 Conclusion: Hypoxic ischemic encephalopathy was the commonest cause of neonatal seizure followed by neonatal infections including meningitis and sepsis.. Biochemical abnormalities are more common in neonates with seizure than neonates free from seizure. Among the biochemical abnormalities hypocalcaemia and hypoglycemia occurs most commonly followed by hyponatraemia and hypomagnesaemia.
 Medicine Today 2020 Vol.32(1): 37-41

ETIOLOGICAL PROFILE OF NEONATAL SEIZURES WITH SPECIAL REFERENCE TO BIOCHEMICAL ABNORMALITIES

Introduction: Neonatal seizure are the most frequent manifestation of neurological dysfunction in a neonate. Detection of seizure and its etiology is important for guiding therapy. In the presence of biochemical abnormalities, it is difficult to control seizures and there is a risk of further brain damage. Early recognition and treatment of biochemical abnormalities are essential for optimal management and satisfactory long term outcome. The aim was to determine the etiology of neonatal seizures and to study the biochemical abnormalities.
 Material and Methods: The present study included 70 inborn neonates presenting with seizures admitted to the neonatal unit in MMIMSR, Mullana, Ambala, Haryana, India over a period of one and a half years. A detailed history was taken and clinical examination of the neonate was done. Etiological causes and various biochemical parameters were evaluated.
 Results: Neonatal seizures occurred more commonly in males. The most common cause of neonatal seizures was birth asphyxia seen in 26 (37.1%) neonates followed by sepsis in 24 (34.3%) neonates. The Primary Biochemical abnormalities were seen in 12 (17.1%) neonates with seizures. Among these neonates, hypoglycemia was most commonly seen in 4 (33.3%) neonates followed by hypocalcemia seen in 3 (25%) neonates.
 Conclusion: Biochemical abnormalities are common in neonatal seizures and often go unrecognized. These abnormalities may significantly contribute to seizure activity and hence a biochemical workup is necessary for all cases of neonatal seizures.

Clinico-epidemiological study of neonatal seizures from a tertiary care hospital of Western Rajasthan, India

Background: Neonatal Seizures are frequent may be either symptoms of an underlying disorder and malfunction of the developing CNS or due to a primary epileptic condition. Their varied clinical presentations, delay in recognition and treatment results in poor neurological outcome. This study attempts to find out the clinical and etiologic profile of neonatal seizures and associated biochemical abnormalities in this geographical part of India.Methods: A hospital based prospective observational study undertaken in a tertiary care pediatric hospital of Medical College Jodhpur India, on 202 consecutive neonates who presented with seizures during period of one year. A detailed antenatal history and baseline characteristics of convulsing neonate at admission and clinical details of each seizure episode reported by the mother and subsequently observed by doctors on duty were recorded. Venous blood sample was analyzed as soon as possible for blood glucose, total serum calcium levels and electrolytes, before instituting any treatment. Data were managed on Microsoft Excel spreadsheet, and analysis was performed using SPSS version.Results: The overall frequency of neonatal seizures in our set up was recorded as 4.08%. Perinatal asphyxia with subsequent HIE was the most common (40.09%) cause of neonatal seizures while hypoglycemia was the most common metabolic cause (11.38%) observed specially in VLBW babies. Subtle seizures were the most common type (34.65%) and tonic seizures were the second most common (33.66%) type of seizures encountered. Hypocalcemia was the second commonest biochemical abnormality found in primary metabolic seizures. HIE, ICH and Hypoglycemia were the common seizure etiology in preterm neonates.Conclusions: Perinatal asphyxia and subsequent HIE was the commonest etiology with subtle, tonic and multifocal seizures being the commonest clinical types encountered. Hypoglycemia and hypocalcemia were the most frequent biochemical abnormality found.

Clinically diagnosed neonatal seizures in Al- Diwanyah, an epidemiological study

Neonatal seizures are the most frequent and distinctive manifestations of neurological disturbances during the neonatal period. This retrospective study aimed to determine the incidence rate, causes and risk factors for neonatal seizures in Al-Diwanyah Province during one calendar year from the 1st of January, 2016 to 31st December, 2016
 METHODS.Data were extracted from the records at Maternity and children Teaching Hospital in Al-Diwaniyah. All neonates who had developed clinically recognized seizures before 28 days of life were enrolled in the study. These data included gestational age (full or pre-term infant), maternal diseases and drug intake during the last trimester, family history of seizures, number of parities, consanguinity, mode of delivery (normal vaginal delivery or caesarian section) age and gender of neonate, body weight at birth (normal or low body weight), and age at which seizure has developed (early onset or delayed onset). Biochemical tests were blood sugar and serum calcium.
 
 RESULTS
 Out of 3167 recorded birth in the hospital, 113 neonates have developed seizure with overall incidence rate of 3.57%. Four main causes of seizures were recognized which were: asphyxia (34.5%), hypoglycemia (23%), hypocalcemia (14.16%) and intraventricular hemorrhage (7.08%). However, in 21.42% of cases, the cause(s) was/were undiagnosed.
 DISCUSSION
 Three risk factors (gender, family history of seizures and number of parities) were found to have no significant association with any of these causes of seizures. The other risk factors associated with these causes in different modes. Each of early onset of seizure, mother’s disease during pregnancy, caesarian section delivery and full term infant were significantly associated with hypoglycemia. Hypocalcemia, on the other hand, was significantly associated with delayed onset of seizures and preterm infants with low body weight, while there was very significant association between asphyxia and normal vaginal delivery. Although less frequent than other causes of seizure, intraventricular hemorrhage was found to be significantly associated with three risk factors (delayed onset of seizures, normal vaginal delivery and preterm infants). Finally, a positive significant association was found between consanguinity and undiagnosed causes of seizures
 CONCLUSION.
 These results pointed out the importance of asphyxia and hypoglycemia as the main causes of neonatal seizures. The most important risk factors associated with these causes are normal vaginal delivery, mother’s disease during pregnancy, and low body weight at birth.

Study on etiology and clinical course of neonatal seizures and their outcome

Background: The aim was to explore etiology, clinical course of neonatal seizure sand their and outcome in Narayana Medical College Hospital, Nellore, Andhra Pradesh, India.Methods: Retrospective study of 65 neonates from 1 month to 1 year diagnosed with epilepsy between November 2016 to August 2018.Results: Most common type of seizures seen are subtle (40%), followed by multifocalclonic (20%), tonic (21%), focal clonic (9.2%), clonic (7.7%) and myoclonic (1.6%). Most common cause of neonatal seizures was HIE (41.5%), followed by hypoglycemia (13.8%), intracranial bleed (10.8%), septicemia (10.8%), hypocalcemia (7.7%). The morality percentage is high (18.2%) when seizures occurred before 12 hours, when seizures occurred between 24-48 hrs it is 14.3%, and mortality was least when seizures occurred between 2-6 days (12.5%). Seizures are common in stage IIHIE (81.5%) compared to Stage I &Stage III. Seizures with adverse outcome are generalized myoclonic and focal clonic seizures. Focal clonic and focal tonic seizures are most often associated with focal injury. Generalized tonic seizures, motor automatism and some myoclonic seizures are associated with diffuse brain injury. Prolonged seizure activity, seizures lasting for many days, repetitive seizures, and the need for multiple anticonvulsants to control seizure activity are associated with an increased mortality.Conclusions: Authors conclude that prompt recognition, evaluation and treatment of these neonatal events are important in improving the survival of neonates with seizures.

CHARACTERISTICS OF GLYCEMIC AND MINERAL HEMOSTASIS WHILE NEONATAL CONVULSIONS

This article is devoted to the disbalance of glycemic and mineral hemostasis in the etiopathogenetic mechanism of neonatal seizures. The purpose of the article: to assess the state of glycemic and mineral hemostasis in patients with neonatal convulsions. Materials and methods. 73 patients with neonatal convulsions were under observation. A blood glucose, sodium, potassium, magnesium and calcium content were investigated in all patients. Results. Among patients with neonatal convulsions hypoglycemia was detected 34.3±5.6%, hypocalcemia – 34.3±5.6%, hypomagnesaemia – 9.6±3.1%, combination of hypocalcemia with hypomagnesemia – 11.0±3.7%, hyponatremia – 11.0±3.7%, hyperkalemia and hypokalemia – 6.9±3.0%, and hypernatremia – 4.1±2.3%. Conclusion. Depending on the cause of neonatal seizures, the characteristics of glycemic and mineral hemostasis change.

Biochemical abnormalities in neonatal seizures in term and preterm neonates

Background: Neonatal seizures may arise as a result of diverse etiologies and can have varied presentations. Biochemical abnormalities are commonly observed in neonates which can be either primary or secondary. Early recognition and treatment of biochemical disturbances is essential for optimal management and satisfactory long-term outcome.Methods: A total of 100 neonates presenting with seizures admitted to NICU of JJM Medical College, Davanagere, from November 2015 to April 2017 were enrolled in the study. Detailed antenatal, natal, postnatal history along with detailed examination was done along with baseline characteristics of convulsing were recorded at admission along with relevant biochemical investigations before instituting any specific treatment.Results: In the present study, out of 100 neonates studied, 64 were full term of which 49(76.5%) were AGA and 15(23.5%) were SGA, whereas 36 cases were preterm. Most neonatal seizures occurred in first 3 days of life, i.e. 59% of which majority occurred on first day of life (34%). Birth asphyxia and septicemia are common cause of neonatal seizures in present study (38 cases each), followed by pure metabolic disturbances 19%. In pure metabolic seizures, hypoglycemia (47.8%) is most common more in preterm babies (55%) followed by hypocalcemia.Conclusions: Biochemical abnormalities are common in neonatal seizures and often go unrecognized and may significantly contribute to seizure activity. Hence, a biochemical work up is necessary for all cases of neonatal seizures.

Etiological Profile and Neurodevelopment Outcome of Neonatal seizure

IntroductionNeonatal seizures are the most common manifestation of neurological disorders in newborn period. It is an important determinant of outcome as well. This study aims to delineate the etiological profile and neurodevelopmental outcome of neonatal seizure. It is also aimed to identify the predictors of neurodevelopmental outcome in survivors.
 MethodsWe recruited consecutively 117 neonates with clinically proven seizures admitted in XXXXX hospital, between February 2014 to February 2016. All of them underwent neurological diagnostic testincluding complete blood count, electrolytes, EEG, CSF analysis, neuroimaging depending upon the etiology of seizure in newborn period. After discharge, all infant with neonatal seizure underwent regular neurological examination at least 3 times within first year of life. We tested prognostic value of adverse outcome including developmental delay, post neonatal seizure, vision and hearing impairment.ResultsDuring the study period among total 954 neonates admitted in NICU and neonatal ward, 117 (12.26%) developed clinical seizures. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy 69(59%), followed by infection 20 (17.09%) and metabolic disturbances collectively constituted 16(13.7%). The outcomes were mortality 16(13.7%), post neonatal seizure 18(15.4%), developmental delay 31(26.5%), vision impairment 19(16.2%) and hearing impairment 26 (22.2%).Low Apgar score at 1 minute (p=0.03), low Apgar score at 5 minute (p=0.001), early onset seizure (p<0.001), intractable seizure (p<0.001)and more than one drug used for seizure control (p=0.001) were early prognostic factors for adverse outcome.Key words: hypoxic ischemic encephalopathy, Apgar score, seizure, developmental delay

Etiologies of neonatal seizures in infants of different gestational age

Aim:To determine main etiologies and clinical features of neonatal seizures (NS) in groups of newborns of different gestational age (GA).Materials and Methods. Main etiologies of NS were evaluated in 165 newborns divided into four groups: I – 84 early preterm newborns with GA of 28 weeks or less, II – 52 newborns with 29-32 weeks GA, III – 12 newborns with 33-36 weeks GA, and IV – 17 term infants with GA between 37 and 41 wks.Results. In the above 165 infants, the following causes of NS were found: perinatal hypoxia-ischemia – 72.1% of cases, grade III-IV intracranial hemorrhage – 6.1%, congenital infections in 9.7%, CNS infections (bacterial meningitis and viral meningoencephalitis) – 9.7%, сerebral dysgenesis – 1.2%, and inborn errors of metabolism and neurodegenerative diseases accounted for 1.2%. Intracranial hemorrhage (grade III-IV) was detected in newborns with GA less than 32 wks only. The etiological role of CNS infections was higher in term newborns (23.5%) than in the other groups.Conclusion.In examining newborns with NS, genetic mechanisms should be taken into consideration, especially when no indications of early brain damage are apparent. This approach is important today as targeted therapies of gene-associated epileptic syndromes are becoming feasible. In the present article, the use of levetiracetam in infants with NS and early onset epilepsy is discussed.

CLINICOPATHOLOGICAL STUDY OF NEONATAL SEIZURE WITH SPECIAL REFERENCE TO NEUROIMAGING: A TERTIARY CARE HOSPITAL BASED STUDY

Background: Seizures are most common and distinct clinical manifestation of neurologic dysfunction in the newborn. Its frequency is around 1.5-14/1000 neonates. The occurrence of seizure is positively correlated with structural brain damage and its consequent sequelae are later stages of life. Therefore, we need to initiate an early diagnostic workup to determine the causes. This study was conducted to determine the etiology of neonatal seizure as well as to find out how neuroimaging is useful in early diagnosis.
 Aims and Objectives: The study was carried out with the objectives to find out the etiology of neonatal seizure, especially by using the neuroimaging facilities and to look at the spectrum of brain lesion.
 Materials and methods: Hospital based observational study conducted over a period of 2 years (August 2015 to July 2017) at neonatal wing of SCB Medical College, Cuttack, India. All newborns with history of seizure and those who developed seizure during hospital stay were included in the study. Detailed antenatal histories, examination of the newborn and clinical detail of each seizure episode were recorded. Various data obtained were displayed in tables, charts, statistical analysis of the observations were done using percentages, averages etc.
 Results: Out of 365 cases which had seizure, 233 (63.8%) were males. Term babies (60.76%) and babies weighing more than 2500 gms (57.44%) showed seizures in this study. Most (60.42%) of the cases were born by vaginal delivery who had seizure afterwards. Hypoglycemia, as a cause was found in only 4% of cases. HIE was the commonest cause (51.8%) followed by metabolic abnormalities (23.2%). Most of them showed abnormality in TC-USG, CT-Brain, MRI brain.
 Conclusion: Most common cause of neonatal seizure is HIE and in maximum cases it is seen in first 72 hours of life. Screening of high risk pregnancies should be strengthened and early referral should be arranged. Imparting NRP training to all health caregivers and improvement of NICU standard in tertiary care centre will reduce the morbidity and mortality.

Lissencephaly– a rare cause of neonatal seizures

The most prominent feature of neurologic dysfunction in the neonatal period is seizures. The incidence of neonatal seizures is 0.5-3 per 1000 live births in term infants and 11-13% in premature babies. Although common causes of neonatal seizures comprises HIE, IVH, Sepsis, Hypoglycaemia, Hypocalcaemia etc. Sometimes rare causes like Neuronal migration syndrome can cause seizures in newborn. Lissencephaly is a smooth cerebrum with lack of convolutions of brain caused by defective neuronal migration during 12- 24 weeks of gestation. These Babies generally presents with seizures, developmental delay, difficulty in swallowing and short life span due to respiratory problems. Hereby we present a case of Lissencephaly as a cause of neonatal seizure disorder.

Clinical Study on Etiology, Onset and Clinical Manifestations of Neonatal Seizures

Background: Neonatal seizures are clinically significant because very few are idiopathic. Further investigation leading to prompt diagnosis of the underlying condition is important because many of the etiologies have specific treatment. Time of onset of seizures has correlation with etiology. Objectives: The objective of the present study is to know the etiology of neonatal seizures, to know the time of onset of neonatal seizures and its relation to etiology and to know the various types of seizures in neonates. Methodology: The present study included 127 neonates presenting with Neonatal seizures admitted to NICU (Neonatal Intensive care Unit) of tertiary care hospital from August 2014 to December 2016. Detailed antenatal, natal and post natal history were taken and examination of baby done and HIE staged according to Modified Sarnat's staging. Then relevant investigations were done and etiology of neonatal seizures was diagnosed. Results: In the present prospective study, out of 127 neonates studied, 118 were full-term, among these 88 (69.3%) were AGA (Average for gestational age) and 30 (23.6%) were SGA (Small for gestational age). 7 babies (5.5%) were preterm. Male: Female ratio in our study was 1.6:1. In our study onset of seizures within first 3 days of life was seen in 101 neonates (79.5%). After 3 days of life, 26 neonates developed seizures (20.5%). Onset of seizures within first 3 days of life of had statistically significant correlation with birth asphyxia as the etiology with p<0.001. Subtle seizures were the commonest type of seizures in our study (49 cases – 38.6%), followed by GTS (Generalized tonic seizures - 42 cases – 33.1%), multifocal clonic (19 cases – 15%) and focal clonic seizures (8 cases - 6.3%). Birth asphyxia was the commonest cause of neonatal seizures in our study (84 cases – 66.1%) followed by hypoglycemia (22 cases – 17.3%) and meningitis (11 cases 8.7%). Out of 84 cases of birth asphyxia 66 (78.6%) mothers had prolonged second stage of labour and 28 (33.3%) had MSAF (Meconium Stained Amniotic Fluid). Hypoglycemic seizures were more common in LBW (Low Birth Weight) babies with statistically significant p<0.001. Conclusion: The recognition of etiology of neonatal seizures is often helpful with respect to prognosis and treatment. The most common etiology for neonatal seizure is HIE (Hypoxic ischemic encephalopathy) and is frequently associated with perinatal risk factors. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Hypoglycemic seizures are more common in LBW babies. Subtle seizures are commonest type of clinical seizures, which is difficult to identify, therefore careful observation of at risk newborns is necessary.

Clinical Study on Etiology, Onset and Clinical Manifestations of Neonatal Seizures

Background: Neonatal seizures are clinically significant because very few are idiopathic. Further investigation leading to prompt diagnosis of the underlying condition is important because many of the etiologies have specific treatment. Time of onset of seizures has correlation with etiology. Objectives: The objective of the present study is to know the etiology of neonatal seizures, to know the time of onset of neonatal seizures and its relation to etiology and to know the various types of seizures in neonates. Methodology: The present study included 127 neonates presenting with Neonatal seizures admitted to NICU (Neonatal Intensive care Unit) of tertiary care hospital from August 2014 to December 2016. Detailed antenatal, natal and post natal history were taken and examination of baby done and HIE staged according to Modified Sarnat’s staging. Then relevant investigations were done and etiology of neonatal seizures was diagnosed. Results: In the present prospective study, out of 127 neonates studied, 118 were full-term, among these 88 (69.3%) were AGA (Average for gestational age) and 30 (23.6%) were SGA (Small for gestational age). 7 babies (5.5%) were preterm. Male: Female ratio in our study was 1.6:1. In our study onset of seizures within first 3 days of life was seen in 101 neonates (79.5%). After 3 days of life, 26 neonates developed seizures (20.5%). Onset of seizures within first 3 days of life of had statistically significant correlation with birth asphyxia as the etiology with p<0.001. Subtle seizures were the commonest type of seizures in our study (49 cases – 38.6%), followed by GTS (Generalized tonic seizures - 42 cases – 33.1%), multifocal clonic (19 cases – 15%) and focal clonic seizures (8 cases - 6.3%). Birth asphyxia was the commonest cause of neonatal seizures in our study (84 cases – 66.1%) followed by hypoglycemia (22 cases – 17.3%) and meningitis (11 cases 8.7%). Out of 84 cases of birth asphyxia 66 (78.6%) mothers had prolonged second stage of labour and 28 (33.3%) had MSAF (Meconium Stained Amniotic Fluid). Hypoglycemic seizures were more common in LBW (Low Birth Weight) babies with statistically significant p<0.001. Conclusion: The recognition of etiology of neonatal seizures is often helpful with respect to prognosis and treatment. The most common etiology for neonatal seizure is HIE (Hypoxic ischemic encephalopathy) and is frequently associated with perinatal risk factors. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Hypoglycemic seizures are more common in LBW babies. Subtle seizures are commonest type of clinical seizures, which is difficult to identify, therefore careful observation of at risk newborns is necessary.

Causes and Factors Associated with Neonatal Seizure and its Short-term Outcome: A Retrospective Prognostic Cohort Study.

Neonatal seizures are common, difficult to diagnose and treat, and associated with a great mortality rate and long-term risk of neurodevelopmental impairments. We aimed to determine the etiology, clinical presentation, and neurodevelopmental outcome of neonatal seizures. In this cross-sectional study, 88 neonates, aged < 28 days, admitted to Mofid Children's Hospital, Tehran, Iran, from September 2011 to 2013 with the initial diagnosis of seizure were enrolled by convenient sampling method. Data, including age, gestational age, birth weight, Apgar of the fifth minute, neonatal intensive care unit (NICU) admission, family history, type, cause, and age of seizure, EEG and paraclinic findings, anticonvulsant used for treatment, neurodevelopmental status, and the final outcome, were collected from medical records and the missed cases were completed by phone calls. The frequency and association of variables were analyzed using SPSS software. Among neonates with seizures, 67% were male, 79.5% were born term, and 72.7% had normal birth weight. The most common type of seizure was multifocal clonic seizures (45.5%). The main diagnosis in neonates with seizures was hypoxic-ischemic encephalopathy (HIE) (23.9%) and hypoglycemia (10.22%). The mortality rate was 11.36% during a mean follow-up period of 21.4±6.4 months. Neurodevelopmental assessments showed that 64% were normal, 27% had global delay, and 9% had motor delay. Positive family history of epilepsy (P=0.006), low Apgar score (P=0.002) and epilepsy (P<0.001) were significantly associated with adverse neurodevelopmental outcome. Since HIE and hypoglycemia were the most common cause of neonatal seizures, efforts should be made to improve care during delivery and early breastfeeding.

A Rat Model of Perinatal Seizures Provoked by Global Hypoxia.

Hypoxic-ischemic encephalopathy (HIE) refers to acute brain injury that results from perinatal asphyxia. HIE is a major cause of neonatal seizures, and outcomes can range from apparent recovery to severe cognitive impairment, cerebral palsy, and epilepsy. Acute partial seizures frequently aid in indicating the severity and localization of brain injury. However, evidence also suggests that the occurrence of seizures further increases the likelihood of epilepsy in later life regardless of the severity of the initial injury. Here, we describe a neonatal rat model of seizure-provoking mild hypoxia without overt brain injury that has been used to investigate potential epileptogenic effects of hypoxia-associated seizures alone on neonatal brain development. Clinically, HIE is defined by brain injury, and thus, this model is not intended to mimic clinical HIE. Rather, its utility is in providing a model to understand the dynamic and long-term regulation of brain function and how this can be perturbed by early life seizures that are provoked by a commonly encountered pathophysiological trigger. Additionally, the model allows the study of brain pathophysiology without the potential confound of variable neuroanatomical changes that are reactive to widespread cell death.