Cause Of Neonatal Seizures Research Articles

CLINICOETIOLOGICAL PROFILE OF NEONATAL SEIZURES IN A TERTIARY CARE HOSPITAL

Background: Seizure is one of the most frequently observed clinical sign in neonatal period and may be the only sign of a central nervous system disorder. Its recognition is of paramount importance and a newborn with seizures is in a true medical emergency requiring prompt intervention. Objective: To determine the clinical and etiological profile of seizures among neonates admitted to neonatal unit in a tertiary care hospital. Materials and Methods: It was a prospective, observational, hospital-based study conducted over a period of 1 year (December 2014-November 2015). Nearly, 63 babies either admitted with neonatal seizures or who developed seizures after admission were studied to find the clinical and etiological profile. Detailed history including gestational age, mode of delivery, birth events, Apgar scores and antenatal problems, age of onset, and frequency of seizures was also noted. Seizures were classified on the basis of detailed description by pediatric resident on duty in a predesigned pro forma. Informed written consent of parents was taken before enrolling a baby in study. Results: Sepsis was the most common cause of neonatal seizures (64.9%), followed by birth asphyxia, i.e., hypoxic ischemic encephalopathy (HIE) (48.3%). Hypoglycemia was seen in 21.6% and hypocalcemia in 18.3% cases. Subtle seizures were the most common type of seizures seen in 65% babies, followed by tonic (31.6%), myoclonic (16.6%%), and clonic (6.67%) type. Subtle seizures were commonly seen in cases of HIE. Conclusion: The recognition of clinicoetiology of neonatal seizures is often helpful with respect to prognosis and treatment. The most common etiology for neonatal seizure is sepsis. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Subtle seizures are the most common type of clinical seizures, which is difficult to identify; therefore, careful observation of at risk newborns is necessary.

Maternal Hypovitaminosis D as a Cause of neonatal seizure

Maternal hypovitaminosis D has many implications for both mother and newborn. The prevalence of vitamin D deficiency in Bhutan is not yet known. The case presented below represents a severe symptomatic presentation of vitamin D deficiency in a neonate due to maternal vitamin D deficiency. It highlights the need for raised suspicion of vitamin D deficiency as a cause of late-onset neonatal seizures, epidemiologic studies, and potential vitamin supplementation for pregnant women, as well as the need for vitamin D-only liquid supplements in pharmacies in Bhutan.

Incidence and outcome of neonatal seizures at a tertiary care hospital

Background: Seizures are associated with poor neuro developmental outcome if not diagnosed early and treated properly. During newborn period, seizures indicate underlying neurological disease. Neonatal seizures lead to increased morbidity and mortality usually found in neonatal intensive care unit. The objective of this study was to evaluate incidence and outcome of neonatal seizures.Methods: Present study was hospital based prospective study conducted among 117 neonates of 0-28 days of age at a tertiary care hospital for a period of one year. The data like history, clinical examination and investigation findings was recorded in the pre-designed, pre-tested, semi structured questionnaire.Results: The incidence of neonatal seizures was higher in male neonates. Subtle types of seizures were the commonest type of seizures. In term neonates, the birth asphyxia was the most common cause of neonatal seizures. The incidence of intra-ventricular hemorrhage (IVH) was significantly higher in preterm than term neonates. Out of biochemical abnormalities, the hypocalcemia was the most common cause of the neonatal seizures. Common causes of neonatal deaths in our center were severe birth asphyxia, intra-ventricular hemorrhage (IVH), septicemia and meningitis. Conclusions: Most of the causes of neonatal seizures are preventable by good perinatal care and early interventions while metabolic seizures need a sharp vigilance and early suspicion.

Prevalence of hypomagnesemia in neonatal seizures in a tertiary care hospital in South India

Introduction: Metabolic causes of neonatal seizures with good prognosis are hypoglycemia, hypocalcemia, hypomagnesemia. Some of hypocalcmic seizures are accompanied by hypomagnesemia, but magnesium levels are rarely investigated in resource restricted hospitals. Materials and Methods: A group of 150 neonates with seizures were studied. Analysis of serum Calcium, Magnesium and Sodium were done on the samples using conventional methods. Prevalence of hypomagnesemia, hypocalcemia and their association was estimated. Results: Metabolic abnormalities were present in 89 (59.3%) out of 150 cases. Of these, hypoglycemia and hypocalcemia were the most common with 39 (43.8%) and 28 (35.4%) cases respectively. The prevalence of hypomagnesemia was 5.3%. 87% of hypomagnesemia cases were associated with hypocalcemia implying the interrelation in pathophysiology. Among neonates with hypocalcemia, 20% had hypomagnesemia. Hence, there is a need to estimate magnesium levels in neonatal seizures because treatment is definitive with magnesium salts. Conclusion: Hypomagnesemia was a significant cause of neonatal seizures. Most of the neonates with hypomagnesemia had an associated hypocalcemia. It is necessary to estimate levels of magnesium in addition to calcium in all neonates with seizures.

Effects of P2X7 receptor antagonists on hypoxia-induced neonatal seizures in mice

Neonatal seizures are a common consequence of hypoxic/ischemic encephalopathy (HIE). Phenobarbital remains the frontline treatment for neonatal seizures but is often ineffective. The P2X7 receptor (P2X7R) is a cell surface-expressed ionotropic receptor activated by high amounts of ATP which may be released during seizures or as a consequence of tissue injury. Here, we explored the role of the P2X7R in a mouse model of neonatal seizures induced by hypoxia. Exposure of postnatal day 7 (P7) mouse pups to global hypoxia (5% O2 for 15 min) produced electrographically-defined seizures with behavioural correlates that persisted after restitution of normoxia. Expression of the P2X7R showed age-dependent increases in the hippocampus and neocortex of developing mice and was present in human neonatal brain. P2X7R transcript and protein levels were increased 24 h after neonatal hypoxia-induced seizures in mouse pups. EEG recordings in pups determined that injection of the P2X7R antagonist A-438079 (25 mg/kg−1, intraperitoneal) reduced electrographic seizure number, EEG power and spiking during hypoxia. A-438079 did not reduce post-hypoxia seizures. Caspase-1 processing and molecular markers of inflammation and microglia were reduced in A438079-treated mice. Electrographic seizure-suppressive effects were also observed with a second P2X7R antagonist, JNJ-47965567, in the same model. The present study shows hypoxia-induced seizures alter expression of purinergic and neuroinflammatory signalling components and suggest potential applications but also limitations of the P2X7R as a target for the treatment of HIE and other causes of neonatal seizures.

Neonatal Seizures: Incidence, Etiologies, Clinical Features and EEG Findings in the Neonatal Intensive Care Unit

Objective: To evaluate the incidence, etiologies, clinical features and EEG findings of seizures among the neonates admitted to one medical center. Method: We retrospectively reviewed the medical records of neonates who were diagnosed to have neonatal seizure at the Neonatal Intensive Care Unit (NICU) of one medical center in Taiwan from January to December 2015. The clinical pictures, laboratory data, image and EEG findings were reviewed in all cases. Results: Neonatal seizures were diagnosed in 22 among 122 neonatal admissions in NICU in 2015. The most common type of seizures observed were subtle (77.2%), followed by tonic (13.7%) and clonic (9.1%) seizures. Acidosis was noted in cases with perinatal asphyxia and shock. The other laboratory data was non-contributory. Seventeen (77.3%) cases had abnormal EEG (focal spikes in majority) and 12 (54.5%) cases had abnormal image findings. Perinatal asphyxia (59.1%) was the most common cause of neonatal seizures, followed by CNS infection (18.2%), malformation syndrome (9.1%) and intracranial hemorrhage (9.1%). Conclusion: Neonatal seizures were found in about 18% of our NICU admissions in one year and the most common was subtle type. Perinatal asphyxia was the most common etiology of neonatal seizures, followed by CNS infection. EEG plays a major role in the diagnosis and follow-up of neonatal seizures.

A Study on Clinico-Biochemical Profile of Neonatal Seizure

Background: Seizure is the most frequent sign of neurologic dysfunction in the neonate. Biochemical disturbances occur frequently in neonatal seizures either as an underlying cause or as associated abnormalities. In their presence, it is difficult to control seizures and there is a risk of further brain damage. Early recognition and treatment of biochemical disturbances are essential for optimal management and satisfactory long-term outcome. The aims were to study the biochemical abnormalities in neonatal seizures and to describe the clinical presentation, time of onset and its relation to etiology of neonatal seizures. Methods: The present study included 115 neonates presenting with seizures admitted to neonatal unit, in a teaching institute, Agartala, Tripura, India during the period of 1.5 years from November 2013 to April 2015. Detailed antenatal, natal and postnatal history was taken and examination of baby was done. Then, relevant investigations including biochemical parameters were done and etiology of neonatal seizures and their associated biochemical abnormalities were diagnosed. Results: In the present study, out of 115 neonates studied, 105 were full-term, of which 94 (81.7%) were AGA and 11 (9.6%) were SGA, nine (7.8%) were preterm and one (0.9%) was post-term babies. One hundred and thirteen (98.3%) were hospital deliveries and 104 (90.4%) were spontaneous vaginal deliveries. Seventy-five (65.2%) were with birth weight > 2.5 kg. In our study, 82 (80%) cases had onset of seizures within first 3 days. The highest number is seen on first day of life (66, 57.4%). Birth asphyxia was the cause in 92.1% of neonates who developed seizures on first day of life. Subtle seizures were the most common type of seizures in our study (49, 42.6%). Birth asphyxia was the most common cause of neonatal seizures in our study (64, 56%), followed by neonatal meningitis (24, 21%) and metabolic disorders (13, 11%). The most common biochemical abnormality detected in neonatal seizures in our study was hyponatremia (26, 65%), of which 21 (72.4%) were due to hypoxic ischemic encephalopathy (HIE), and the rest were due to neonatal meningitis (5, 55.6%). In metabolic seizures, hypoglycemia (66.7%) was common, and more so in low birth weight babies (55%). Incidence of hypomagnesemia with hypocalcemia occurred in two (1.73%) cases. Conclusions: The most common etiology of neonatal seizures is HIE and onset is during first 3 days of life. Hyponatremia is the most common biochemical abnormality associated with non-metabolic seizures, mainly HIE. Hypoglycemia is a more common metabolic disorder, more so in low birth weight. Incidence of hypomagnesemia with hypocalcemia is low but recognition of such abnormality has important therapeutic implications. J Neurol Res. 2016;6(5-6):95-101 doi: https://doi.org/10.14740/jnr404w

Serum zinc status of neonates with seizure

Background: Seizure is a common neurological disorder in neonatal age group!. Primary metabolic derangement is one of the important reason behind this convulsion during this period. Among primary metabolic derangement hypoglycemia, is most common followed by bypocalcaemia, hypomagnesaemia, low zinc status etc. As causes of many cases of convul­sion remain unknown in neonate. Objectives: To see the zinc status in the sera of neonate with convulsion. So that if needed early intervention can be taken up and thereby prevent complications. Method: A total of 50 neonates (1-28 days) who had convulsion with no apparent reasons of convulsion were enrolled as cases and 50 healthy age and sex matched neonates were enrolled as controls. After a quick clinical evaluation serum zinc status was estimated from venous blood by atomic absorption method in Chemistry Division, Atomic Energy Centre. Low zinc was considered if serum value was <0.7mg/L. Results: Among a total of 50 cases 6% had low zinc value & 2% of controls also had low zinc level. The mean serwu zinc level of cases and controls were 1.57±0.95 and 2.37±1.06 mmol/1 respectively (p<0.01). Conclusion: From the study it is seen that low zinc value is an important cause of neonatal seizure due to primary metabolic abnormalities. So early recognition and treatment could save these babies from long term neurological sequelies.

A Study on Clinico-Biochemical Profile of Neonatal Seizure

Background: Seizure is the most frequent sign of neurologic dysfunction in the neonate. Biochemical disturbances occur frequently in neonatal seizures either as an underlying cause or as associated abnormalities. In their presence, it is difficult to control seizures and there is a risk of further brain damage. Early recognition and treatment of biochemical disturbances are essential for optimal management and satisfactory long-term outcome. The aims were to study the biochemical abnormalities in neonatal seizures and to describe the clinical presentation, time of onset and its relation to etiology of neonatal seizures. Methods: The present study included 115 neonates presenting with seizures admitted to neonatal unit, in a teaching institute, Agartala, Tripura, India during the period of 1.5 years from November 2013 to April 2015. Detailed antenatal, natal and postnatal history was taken and examination of baby was done. Then, relevant investigations including biochemical parameters were done and etiology of neonatal seizures and their associated biochemical abnormalities were diagnosed. Results: In the present study, out of 115 neonates studied, 105 were full-term, of which 94 (81.7%) were AGA and 11 (9.6%) were SGA, nine (7.8%) were preterm and one (0.9%) was post-term babies. One hundred and thirteen (98.3%) were hospital deliveries and 104 (90.4%) were spontaneous vaginal deliveries. Seventy-five (65.2%) were with birth weight > 2.5 kg. In our study, 82 (80%) cases had onset of seizures within first 3 days. The highest number is seen on first day of life (66, 57.4%). Birth asphyxia was the cause in 92.1% of neonates who developed seizures on first day of life. Subtle seizures were the most common type of seizures in our study (49, 42.6%). Birth asphyxia was the most common cause of neonatal seizures in our study (64, 56%), followed by neonatal meningitis (24, 21%) and metabolic disorders (13, 11%). The most common biochemical abnormality detected in neonatal seizures in our study was hyponatremia (26, 65%), of which 21 (72.4%) were due to hypoxic ischemic encephalopathy (HIE), and the rest were due to neonatal meningitis (5, 55.6%). In metabolic seizures, hypoglycemia (66.7%) was common, and more so in low birth weight babies (55%). Incidence of hypomagnesemia with hypocalcemia occurred in two (1.73%) cases. Conclusions: The most common etiology of neonatal seizures is HIE and onset is during first 3 days of life. Hyponatremia is the most common biochemical abnormality associated with non-metabolic seizures, mainly HIE. Hypoglycemia is a more common metabolic disorder, more so in low birth weight. Incidence of hypomagnesemia with hypocalcemia is low but recognition of such abnormality has important therapeutic implications. J Neurol Res. 2016;6(5-6):95-101 doi: https://doi.org/10.14740/jnr404w

White matter injury following rotavirus infection in neonates: new aspects to a forgotten entity, 'fifth day fits'?

That rotavirus infection can cause neurological symptoms in young children has been well established. However, it is surprising why rotavirus infection has been overlooked as a cause of neonatal seizures for many years, despite significant research interest in neonatal rotavirus infection. Neonates are the age group most vulnerable to seizures, which are typically attributed to a wide range of causes. By contrast, because rotavirus infection is usually asymptomatic, it has been difficult to identify an association between this virus and neonatal seizures. The conventional wisdom has been that, although neonates are commonly infected with rotavirus, neurological complications are rare in this age. However, recent studies using diffusion-weighted imaging (DWI) have suggested a connection between rotavirus infection and neonatal seizures and that rotavirus infection can induce diffuse white matter injury without direct invasion of the central nervous system. The clinical features of white matter injury in rotavirus-infected neonates include the onset of seizures at days 4–6 of life in apparently healthy term infants. The recent findings seem to contradict the conventional wisdom. However, white matter injury might not be a completely new aspect of rotavirus infection in neonates, considering the forgotten clinical entity of neonatal seizures, 'fifth day fits'. With increased use of DWI in neonatal seizures, we are just starting to understand connection between viral infection and white matter injury in neonates. In this review, we discuss the historical aspects of rotavirus infection and neonatal seizures. We also present the clinical features of white matter injury in neonatal rotavirus infection.

The clinical profile, etiology and short term outcome of neonatal seizures at Patan Hospital, Nepal

Introduction: The incidence of seizure is as high as 5/1000 live births and the mortality rate can be up to 15%. So this study was conducted to find out the clinical profile, causes and immediate outcome of neonatal seizures at Patan Hospital. Methods: In this retrospective study, all neonates (aged 0-28 days) with seizure admitted to Patan Hospital over a period of one year from January 2015 to December 2015 were included. The data were obtained from hospital records and analyzed using SPSS 12. Results: There were 32 cases of neonatal seizures admitted over the period of one year out of which 23 were born at Patan Hospital. The incidence of neonatal seizure was 2.9 cases of per 1000 live birth. Among neonates with seizure, 63% were male, 81% were term and 69% were of birth weight more than 2500gm. The cause of seizure was hypoxic ischemic encephalopathy in 25% of cases and no cause could be found in 15% of cases. Phenobarbitone alone controlled seizure in more than 50% of cases. The mortality rate was 9.3% with hypoxic ischemic encephalopathy being the most common cause. Conclusion: The most common cause of neonatal seizure is hypoxic ischemic encephalopathy and is also the leading cause of death in neonates with seizure. Therefore improvement in healthcare during the delivery of newborns can decrease the incidence and death due to neonatal seizure.

Age- and sex-dependent susceptibility to phenobarbital-resistant neonatal seizures: role of chloride co-transporters.

Ischemia in the immature brain is an important cause of neonatal seizures. Temporal evolution of acquired neonatal seizures and their response to anticonvulsants are of great interest, given the unreliability of the clinical correlates and poor efficacy of first-line anti-seizure drugs. The expression and function of the electroneutral chloride co-transporters KCC2 and NKCC1 influence the anti-seizure efficacy of GABAA-agonists. To investigate ischemia-induced seizure susceptibility and efficacy of the GABAA-agonist phenobarbital (PB), with NKCC1 antagonist bumetanide (BTN) as an adjunct treatment, we utilized permanent unilateral carotid-ligation to produce acute ischemic-seizures in post-natal day 7, 10, and 12 CD1 mice. Immediate post-ligation video-electroencephalograms (EEGs) quantitatively evaluated baseline and post-treatment seizure burdens. Brains were examined for stroke-injury and western blot analyses to evaluate the expression of KCC2 and NKCC1. Severity of acute ischemic seizures post-ligation was highest at P7. PB was an efficacious anti-seizure agent at P10 and P12, but not at P7. BTN failed as an adjunct, at all ages tested and significantly blunted PB-efficacy at P10. Significant acute post-ischemic downregulation of KCC2 was detected at all ages. At P7, males displayed higher age-dependent seizure susceptibility, associated with a significant developmental lag in their KCC2 expression. This study established a novel neonatal mouse model of PB-resistant seizures that demonstrates age/sex-dependent susceptibility. The age-dependent profile of KCC2 expression and its post-insult downregulation may underlie the PB-resistance reported in this model. Blocking NKCC1 with low-dose BTN following PB treatment failed to improve PB-efficacy.

Neonatal seizures in hypoxic-ischaemic encephalopathy--risks and benefits of anticonvulsant therapy.

The risk of seizures is at its highest during the neonatal period, and the most common cause of neonatal seizures is hypoxic-ischaemic encephalopathy (HIE). This enhanced vulnerability is caused by an imbalance in the expression of receptors for excitatory and inhibitory neurotransmission, which is age dependent. There has been progress in detecting the electrophysiological abnormalities associated with seizures using amplitude-integrated electroencephalography (aEEG). Data from animal studies indicate a variety of risk factors for seizures, but there are limited clinical data looking at the long-term neurodevelopmental consequences of seizures alone. Neonatal seizures are also associated with increased risk of further epileptic seizures; however, it is less clear whether or not this results from an underlying pathology, and whether or not seizures confer additional risk. Phenobarbital and phenytoin are still the first-line antiepileptic drugs (AEDs) used to treat neonatal seizures, although they are effective in only one-third of affected infants. Furthermore, based on findings from animal studies, there are concerns regarding the risks associated with using these AEDs. Clinicians face a difficult challenge because, although seizures can be easily identified using aEEG, treatment options are limited, and there are uncertainties regarding treatment outcomes. There is a need to obtain long-term follow-up data, comparing groups of infants treated with or without current therapies. If these analyses indicate a definite benefit of treating neonatal seizures, then novel therapeutic approaches should be developed.

To study the incidence, etiology and EEG profile of neonatal seizures: a prospective observational study from India

Aim: To study the incidence, etiology and electroencephalography (EEG) profile of neonatal seizures and also to study the correlation between clinical picture and EEG appearance. Type of study: Prospective observational cohort study. Study duration: September 2011 to April 2013. Inclusion and exclusion: Seizures within first 28 d of life and seizures documented by doctors. Population: Neonates admitted in intensive care unit: intramural (4412) and extramural (1900) admissions (all together 6312). Materials and methods: One hundred and seventy-two neonates with seizures were enrolled. All the neonates were evaluated with necessary investigation, ultrasound head and CT scan. All the neonates underwent EEG as early as possible with neonatal stabilization. The etiology of neonatal seizures, CT scan and ultrasound head, characteristic of the EEG and neonatal mortality were noted. Results: The incidence of neonatal seizure was 0.77% in the intramural and 7.3% among the extramural neonates. The incidence of seizures in term newborn was 0.7% and in preterm was 1.1%. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy (HIE) followed by hypocalcemia. The predominant seizure type was multifocal (51%) followed by subtle seizure (43%). There was an EEG abnormality in 72% of the total EEG with varied patterns. The mortality rate in the cohort was 15% with HIE being the most common cause. Conclusion: Most common cases of neonatal seizure were HIE and with the most common type being multifocal. EEG was abnormal in the majority of the neonates with various pattern of abnormality.

Clinicoetiological profile and outcome of neonatal seizures

Background: Neonatal seizures are abnormal electrical discharge in the central nervous system of neonates, usually manifesting as stereotyped muscular activity or automatic changes. This study aims to determine the, clinical types, etiological factors and developmental outcome of neonatal seizures. Methods: It is a prospective study conducted in NICU of PBM Hospital, Bikaner, India. Total 1278 neonates were admitted, out of which 150 had seizures. Details of history, examination and investigations were recorded on predesigned performa. Cases were followed at 6 months of age for developmental outcome. Results: Intramural and extramural incidence of seizures was 1.42% and 10.16% respectively. Incidence in extreme low birth weight, very low birth weight and in low birth weight was 29.41%, 26.71% and 10.73% respectively. Male preponderance with male to female ratio was 1.73:1. 96 (64%) neonates born to primi and 54 (36%) were born to multiparous mother. Most common type of neonatal seizure is subtle 95 (63.33%) followed by generalized tonic 29 (19.33%), multifocal clonic 15 (10%), focal tonic and focal clonic 4 (2.67%) each and myoclonic 3 (2%). Most common cause of neonatal seizures is perinatal asphyxia 80 (53%) followed by metabolic causes 24 (16%), infections 15(10%), intracranial hemorrhage in 7 (4.66%), meconium aspiration syndrome (MAS) 5 (3.33%), bilirubin encephalopathy and polycythemia 2 (1.33%) each and 12 (8%) had undetermined etiology. Conclusions: Most common type of neonatal of neonatal seizure is subtle, most common cause is perinatal asphyxia. Excellent outcome was seen in seizures due to electrolyte imbalance, MAS, neonatal septicemia, bronchopneumonia and polycythemia. Worst outcome was with HIE (Hypoxic ischemic encephalopathy) grade III and encephalitis.

Pharmacologic Management of Neonatal Seizures.

Seizures are most often the only sign of a central nervous dysfunction in the neonate. Neonatal seizures are a symptom of a specific disease entity. The search for a cause of neonatal seizures should focus on perinatal history or acute metabolic changes in the neonate. There are four classifications of neonatal seizures: clonic, tonic, myoclonic, and subtle. Simultaneous electroencephalogram and video recording are tools to assist the practitioner in the evaluation of difficult-to-assess subtle behaviors. Although many seizures may be prevented by careful attention to metabolic changes and the neonate's overall condition, those that cannot be prevented may require pharmacologic treatment. First-generation antiepileptic drugs such as phenobarbital and phenytoin are still the first and second lines of therapy, even as questions concerning their limited clinical effectiveness and concern for potential neurotoxicity continue.

PO-0386 Neonatal Seizures On Aeeg Monitoring After In Utero Exposure To Venlafaxine

We report an unusual presentation of withdrawal from venlafaxine in a preterm baby of 29 weeks gestation, who presented with myoclonic seizures on second day of life. The seizures were confirmed with amplitude integrated EEG (aEEG). Other causes of neonatal seizures were excluded. She responded to treatment with phenobarbitone and phenytoin. Her MRI scan of the brain was normal and remains well on follow up. We believe this case to be the first report of seizure in a preterm baby resulting from maternal venlafaxine use and details the contribution of aEEG in the care of one such infant. (I should declare that I have presented this poster in an educational meeting in India. As it has come out nicely, I wish to present the poster again to European audience. I should also declare that information in this case has been used for a case report which has been accepted for publication in a journal. Thank you).

Recent advances in neonatal seizures.

Neonatal seizures are the most important indicators of underlying brain injury. Seizures in a neonate are different from seizures in older children in many aspects including clinical presentation and etiology. The neonatal brain is immature and tends to have a decreased seizure threshold. Neonatal seizures are classified, based on their presentation as, clinical seizures, electroclinical seizures and electroencephalographic seizures; based on the pathophysiology as epileptic and nonepileptic seizures; and also on the basis of the etiology. Hypoxic ischemic encephalopathy is the leading cause of neonatal seizures, followed by intracranial hemorrhage, metabolic causes such as hypoglycemia and hypocalcemia, intracranial infections and strokes. Neonatal epilepsy syndromes are rare. Electroencephalography (EEG) is the gold standard for diagnosis. Amplitude integrated EEG (aEEG) is also used for continuous monitoring. The approach to management consists of initial stabilization of the neonate followed by treatment of potentially correctable injurious processes such as hypocalcemia, hypoglycemia and electrolyte disturbances, etiology specific therapies and antiepileptic drug (AED) therapy. Phenobarbital remains the first line AED therapy. Pharmacokinetic data on newer drugs is limited. Prognosis depends on the etiology, seizure type, neurological examination at discharge and EEG. Long term neurodevelopmental follow up is essential for babies with neonatal seizures.

Neonatal seizures: Aetiology by means of a standardized work-up

Neonatal seizures are an alarming symptom and are frequent in neonates. It is important to find the cause of neonatal seizures to start a specific treatment and to give a meaningful prognosis. The aim of this study is to investigate the incidence of different aetiologies of neonatal seizures in our hospital by a specific work-up. MethodsAll full-term born neonates from January 2002 till September 2009 with neonatal seizures, admitted to our neonatal intensive care unit were included (n = 221). Aetiology was investigated by means of a standardized aetiologic work-up. ResultsThe frequencies of aetiologies of neonatal seizures were: hypoxic-ischemic encephalopathy (HIE) (n = 119; 53.9%), metabolic or electrolyte disorders (n = 24; 10.9%), intracranial hemorrhage (n = 20; 9.0%), ischemic infarction (n = 16; 7.2%), intracranial infections (n = 14; 6.3%), congenital malformations of the central nervous system (n = 7; 3.2%), inborn errors of metabolism (n = 5; 2.3%), epileptic syndromes (n = 1; 0.5%), HIE + hypoglycemia (n = 4; 1.8%), HIE + intracranial hemorrhage (n = 3; 1.4%), HIE + ischemic infarction (n = 1; 0.5%), ischemic infarction + intracranial hemorrhage (n = 1; 0.5%), idiopathic (n = 4, 1.8%), intoxications (n = 1; 0.5%) and unknown (n = 1; 0.5%). ConclusionOur work-up is a practical tool to find the aetiology of neonatal seizures.

Management of refractory neonatal seizures

Management of refractory neonatal seizures David Neubauer,1 Aneta Soltirovska-Salamon,2 Damjan Osredkar,3 Darja Paro-Panjan21Department of Child, Adolescent and Developmental Neurology, 2Department of Neonatology, University Children's Hospital Ljubljana, Ljubljana, Slovenia; 3University of Oslo, Oslo, NorwayAbstract: The risk of seizures is highest during the neonatal period. Currently used therapies have limited efficacy and the treatment of neonatal seizures has not significantly changed in recent decades. Controversies still exist as to whether neonatal seizures can cause damage to the developing brain per se, or if the associated neurodevelopmental problems are caused by the underlying condition(s). However, during recent years, there has been substantial progress in the diagnostic possibilities for uncovering the etiologic cause of seizures. This article addresses the most common and important (treatable) etiologic causes of neonatal seizures, and discusses some of the diagnostic tools available. Current therapeutic approaches and their efficacy are discussed, with the aim to present the current knowledge on the topic.Keywords: neonatal seizures, electroencephalography, etiologic considerations, treatment options