Common Cause Of Neonatal Seizures Research Articles

TO STUDY CLINICAL PRESENTATION AND TIME OF ONSET OF SEIZURE IN TERM AND PRETERM NEONATES AND THE BIOCHEMICALABNORMALITY IN SEIZURES IN TERM AND PRETERM NEONATES.

INTRODUCTION: Seizure is dened as paroxysmal involuntary disturbance of brain function. It may manifest as impairment or loss of consciousness, abnormal motor activity, behavioural abnormality, sensory disturbance or autonomic dysfunction. Any abnormal, repetitive and stereotypic behaviour in neonates should be evaluated as possible seizure. Neonatal seizures is a common neurological problem with a frequency range from 0.95 to 3.5/1000 live births. AIMS & OBJECTIVES:To assess the importance of biochemical abnormalities in neonatal seizures and to evaluate clinical presentation & time of onset of seizures in term and preterm neonates. MATERIAL & METHODS: A total of 90 neonates presenting with seizures admitted to NICU of National Institute of Medical Sciences & Research, Jaipur from conducted from 1st January 2019 till 30 th June 2020 were enrolled in the study. Detailed antenatal, natal, postnatal history along with detailed examination was done. Baseline characteristics of convulsing neonate including sex, gestational age, birth weight, head circumference & length were recorded at admission. Clinical details of each seizure episode reported by the mother and subsequently observed by the resident doctors on duty were recorded i.e. age at onset of seizures, duration of seizure, number and type of seizure. Relevant investigations including biochemical parameters were done immediately after baby had seizures and before instituting any specic treatment. Etiology of neonatal seizures and associated biochemical abnormalities were diagnosed. RESULTS: In the present study, out of 90 neonates studied, 64 were full term of which 49(76.5%) were AGAand 15(23.5%) were SGA, whereas 26 cases were preterm. The male: female ratio is 1.3:1. Most neonatal seizures occur in rst 3 days of life, i.e. 60 %. Most of them occurred on rst day of life (34%). Birth asphyxia was the cause of neonatal seizures in 82 % neonates who developed seizures on day-1 of life. Birth asphyxia and septicemia are common cause of neonatal seizures in our study, followed by pure metabolic disturbances 20 %. In pure metabolic seizures, hypoglycemia (47.8%) is most common more in preterm babies (55%) followed by hypocalcemia. In cases of non- metabolic seizures, which showed associated biochemical abnormalities, hypoglycemia was most common abnormality 24 of 52 cases (46.15%). 12 cases (52.1%) are associated with birth asphyxia and 11 cases (47.9%) are associated with septicemia. CONCLUSION: Biochemical abnormalities are common in neonatal seizures and often go unrecognized. These abnormalities may signicantly contribute to seizure activity correction of these abnormalities may play a signicant role in seizure control. Hence, a biochemical work up is necessary for all cases of neonatal seizures.

Prevalence of Biochemical Abnormalities in Neonatal Seizures in Term and Preterm Neonates

Background: The most vulnerable period of life to develop seizures is the neonatal period. These events very often signify serious damage or malfunction of the immature developing central nervous system. Neonatal seizures may arise as a result of diverse etiologies and can have varied presentations. Biochemical abnormalities are commonly observed in neonates who are admitted in neonatal intensive care unit with seizures. Early recognition and treatment of biochemical disturbances is essential for optimal management and satisfactory long-term outcome.
 Objective: To assess clinical types and importance of biochemical abnormalities in neonatal seizures and to evaluate clinical type & time of onset of seizures in term and preterm neonates.
 Methods: A prospective observational study, where 100 neonates presenting with seizures admitted to neonatal intensive care unit of Jagadguru Jayadeva Murugarajendra Medical College, Davangere, from September 2015 to August 2017 were enrolled in the study. The detailed history along with clinical examination, baseline characteristics of convulsing neonate were recorded at admission. Clinical details of each seizure episode reported by the mother and subsequently observed by the resident doctors on duty were recorded. The relevant biochemical investigations were done immediately after baby had seizures and before instituting any specific treatment. The descriptive statistics such as mean and standard deviation (SD) for continuous variables, frequencies and percentages were calculated for categorical variables. The association between gestational age and other categorical variables were analyzed using chi-square test of independence. The comparison of mean of various quantitative variables was analyzed using ANOVA test. Etiology of neonatal seizures and associated biochemical abnormalities were diagnosed.
 Results: In the present study, out of 100 neonates studied, 64 were full term of which 49(76.5%) were appropriate for gestational age and 15(23.5%) were small gestational age, whereas 36 cases were preterm. Most neonatal seizures occur in first 3 days of life, i.e. 59%. Most of them occurred on first day of life (34%). Birth asphyxia was the cause of neonatal seizures in 82.35% neonates who developed seizures on day-1 of life. Birth asphyxia and septicemia are common cause of neonatal seizures in our 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. In cases of non- metabolic seizures, which showed associated biochemical abnormalities, hypoglycemia was most common abnormality 23 of 52 cases (44.2%). 12 cases (52.1%) are associated with birth asphyxia and 11 cases (47.9%) are associated with septicemia. Subtle seizures were most common type of seizures in our study, followed by focal clonic, multifocal clonic, generalized tonic, subtle with GTC and subtle with clonic.
 Conclusion: Biochemical abnormalities are common in neonatal seizures and often go unorganized. These abnormalities may significantly contribute to seizure activity correction of these abnormalities work up is necessary for all cases of neonatal seizures.

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.

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.

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.

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.

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.

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.

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.

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.

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

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 &gt; 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

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.

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.

The Etiology, Clinical Type, and Short Outcome of Seizures in NewbornsHospitalized in Besat Hospital/Hamadan/ Iran.

Seizures in neonates are very different from those of older children and adults. The aim of this study was to determine the etiology, clinical presentation, and outcome of seizures in hospitalized neonates of Besat Hospital, Hamadan, Iran. In this retrospective study, we evaluated all neonates with seizures (aged 0-28 days) admitted to the Besat hospital, Hamadan, over a period of three years from September 2008 to September 2011. The data were obtained from hospital records and analyzed using SPSS 12. Seizures were reported in 102/1112 (9.1%) neonatal admissions. Among neonates with seizures, 57% were male and 23.5% were preterm. The mean birth weight was 2936±677 grams and the mean gestational age was 37.60±1.94 weeks. 16.7% of them were LBW and 2.9% VLBW. In terms of seizure type, subtle seizures were observed in 38.2%, tonic in 29.4%, clonic in 26.4%, and myoclonic in 5.9% of cases. The main diagnosis in neonates with seizures included hypoxic-ischemic encephalopathy (HIE) (34.3%), infections (24.4%), intracranial hemorrhage (6.9%), hypoglycemia (5.9%), hypocalcemia (2.9%), inborn error of metabolism (1%), and unknown cause (24.5%). The mortality rate was 14.7%. Neonatal seizures indicate a significant underlying disease. HIE was the most common cause of neonatal seizures in our study. Therefore, efforts should be made to improve care during childbirth.

Sodium hydrosulfide prevents hypoxia-induced behavioral impairment in neonatal mice

Hypoxic encephalopathy is a common cause of neonatal seizures and long-term neurological abnormalities. Endogenous hydrogen sulfide (H2S) may have multiple functions in brain. The aim of this study is to investigate whether sodium hydrosulfide (NaHS), a H2S donor, provides protection against neonatal hypoxia-induced neurobehavioral deficits. Neonatal mice were subjected to hypoxia (5% oxygen for 120min) at postnatal day 1 and received NaHS (5.6mg/kg) once daily for 3d. Neurobehavioral toxicity was examined at 3–30d after hypoxia. Treatment with NaHS significantly attenuated the delayed development of sensory and motor reflexes induced by hypoxia up to two weeks after the insult. Moreover, NaHS improved the learning and memory performance of hypoxic animals as indicated in Morris water maze test at 30d after hypoxia. In mice exposed to hypoxia, treatment with NaHS enhanced expression of brain derived neurotrophic factor (BDNF) in the hippocampus. Furthermore, the protective effects of NaHS were associated with its ability to repress the hypoxia-induced nitric oxide synthase (NOS) activity and nitric oxide production in the hippocampus of mice brain. Taken together, these results suggest that the long-lasting beneficial effects of NaHS on hypoxia-induced neurobehavioral deficits are mediated, at least in part, by inducing BDNF expression and suppressing NOS activity in the brain of mice.

Melatonin improves short and long-term neurobehavioral deficits and attenuates hippocampal impairments after hypoxia in neonatal mice

Hypoxic encephalopathy is a common cause of neonatal seizures and long-term neurobehavioral abnormalities. The purpose of this study was to determine whether administration of melatonin, starting at 1h before hypoxia and then every 24h for 3 days, influences short and long-term neurobehavioral development and hippocampal impairments in postnatal day 1 mice subjected to hypoxia (5% oxygen and 95% nitrogen for 120min). Melatonin significantly attenuated hypoxia-induced neurobehavioral deficits, including sensorimotor performance, locomotor functions, and hyperactivity up to two weeks after hypoxia insult. The above-mentioned functional benefits of melatonin were associated with attenuation of cell death in the hippocampus. Importantly, melatonin improved learning and memory performance in the Morris water test, as associated with significantly increased proliferating cells (BrdU-positive cells) and differentiating neuroblasts (doublecortin-positive neuroblasts) in the hippocampus of hypoxic animals at 30 days after hypoxia. In addition, melatonin significantly decreased microglial activation and overproduction of pro-inflammatory mediators (tumor necrosis factor-α, interleukin-1β and nitric oxide) from 3 to 30 days after hypoxia, possibly by inhibiting NF-κB activation in the hippocampus. The present results show that melatonin has short- and long-term protective effects against hypoxia-induced neurobehavioral deficits in the neonatal mouse. These beneficial effects are associated with increasing neurogenesis and attenuation of cell death and inflammatory responses in the hippocampus.

Bumetanide enhances phenobarbital efficacy in a rat model of hypoxic neonatal seizures.

Neonatal seizures can be refractory to conventional anticonvulsants, and this may in part be due to a developmental increase in expression of the neuronal Na+-K+-2 Cl− cotransporter, NKCC1, and consequent paradoxical excitatory actions of GABAA receptors in the perinatal period. The most common cause of neonatal seizures is hypoxic encephalopathy, and here we show in an established model of neonatal hypoxia-induced seizures that the NKCC1 inhibitor, bumetanide, in combination with phenobarbital is significantly more effective than phenobarbital alone. A sensitive mass spectrometry assay revealed that bumetanide concentrations in serum and brain were dose-dependent, and the expression of NKCC1 protein transiently increased in cortex and hippocampus after hypoxic seizures. Importantly, the low doses of phenobarbital and bumetanide used in the study did not increase constitutive apoptosis, alone or in combination. Perforated patch clamp recordings from ex vivo hippocampal slices removed following seizures revealed that phenobarbital and bumetanide largely reversed seizure-induced changes in EGABA. Taken together, these data provide preclinical support for clinical trials of bumetanide in human neonates at risk for hypoxic encephalopathy and seizures.

Identification of the Long-Term Effects of Mild to Moderate Neonatal Cerebral Hypoxia Based on EEG Signals Analysis

Abstract Hypoxic-ischemic encephalopathy (HIE) during perinatal period is the most common cause of neonatal seizures and is associated with an increased risk of epilepsy in later life. Among newborns affected by perinatal brain injury 20-50% die during the newborn period, and 25-60% of the survivors suffer from permanent neurodevelopmental handicap, including cerebral palsy, seizures, mental retardation, and learning disabilities. In the present study EEG data from 11 patients were analysed with power spectra analysis of the principal components of the EEG signals, fractal dimension estimation and sample entropy estimation. The preliminiary results show that the power density properties in the alpha frequency range correlate with learning difficulties of the subjects.