Diagnosis Of Neonatal Seizures Research Articles

Neonatal EEG seizure detection using a new signal structural complexity measure based on matching pursuit decomposition with nonstationary dictionary

Background and objectiveIn newborns, it is often difficult to accurately differentiate between seizure and non-seizure based solely on clinical manifestations. This highlights the importance of electroencephalogram (EEG) in the recognition and management of neonatal seizures. This paper proposes an effective algorithm for the detection of neonatal seizure using multichannel EEG. MethodsNeonatal EEG changes morphology as it alternates between seizure and non-seizure states. A new signal complexity measure based on matching pursuit (MP) decomposition is proposed and used to detect transitions between these two states. The new measure, referred to as weighted structural complexity (WSC), was used for the detection of seizures in 30 newborn EEG records. Multiple IIR filters and an MP-based filter were designed and used to remove artifacts from the EEG data. Geometrical correlation between the EEG data channels was applied to reduce the number of false detections caused by remnant artifacts. The seizure detector's performance was assessed using several epoch-based (e.g., accuracy) and event-based (GDR = good detection rate and FD/h = false detections per hour) metrics. ResultsCompared to the neurologist marking, the proposed detector was able to detect EEG seizures with 94% accuracy, 90.9% GDR, and 0.14 FD/h (95% CI: [0.06, 0.34]). ConclusionsThe high performance of the MP-based detector may have significant implications for the accurate diagnosis of neonatal seizures and the appropriate use of anticonvulsants and ongoing clinical assessment and care of the newborn.

Electrographic Seizures in Neonates with a High Risk of Encephalopathy.

Background: Neonatal encephalopathy is caused by a wide variety of acute brain insults in newborns and presents with a spectrum of neurologic dysfunction, such as consciousness disturbance, seizures, and coma. The increased excitability in the neonatal brain appears to be highly susceptible to seizures after a variety of insults, and seizures may be the first clinical sign of a serious neurologic disorder. Subtle seizures are common in the neonatal period, and abnormal clinical paroxysmal events may raise the suspicion of neonatal seizures. Continuous video electroencephalographic (EEG) monitoring is the gold standard for the diagnosis of neonatal seizures. The aim of this study was to identify the prevalence of electrographic seizures and the impact of monitoring in neonates with a high risk of encephalopathy. Methods: We conducted this prospective cohort study in a tertiary neonatal intensive care unit over a 4-year period. Neonates with a high risk of encephalopathy who were receiving continuous video EEG monitoring were eligible. The patients were divided into 2 groups: (1) acute neonatal encephalopathy (ANE) and (2) other high-risk encephalopathy conditions (OHRs). The neonates’ demographic characteristics, etiologies, EEG background feature, presence of electrographic seizures and the impact of monitoring were analyzed. Results: A total of 71 neonates with a high risk of encephalopathy who received continuous video EEG monitoring were enrolled. In this consecutive cohort, 42 (59.2%) were monitored for ANE and 29 (40.8%) were monitored for OHRs. At the time of starting EEG monitoring, 54 (76.1%) of the neonates were term infants. The median gestational age at monitoring was 39 weeks (interquartile range, 37–41 weeks). The median total EEG monitoring duration was 64.7 h (interquartile range, 22.2–72.4 h). Electrographic seizures were captured in 25 of the 71 (35.2%) neonates, of whom 20 (80%) had electrographic-only seizures without clinical correlation. Furthermore, of these 20 neonates, 13 (65%) developed electrographic status epilepticus. Electrographic seizures were most commonly found in the ANE group (17, 40.5%) than in the OHRs group (8, 27.6%) (p = 0.013). Besides, normal/mild abnormality and inactive EEG background were less electrographic seizure than moderate and major abnormality EEG background (2 of 30, 6.7% vs. 23 of 41, 56.1%, p < 0.001). Finally, continuous video EEG monitoring excluded the diagnosis of electrographic seizures in two-thirds of the monitored neonates who had paroxysmal events mimicking seizures and led to a change in clinical management in 39.4% of the neonates. Conclusions: Our findings showed that monitoring could accurately detect seizures, and that it could be used to guide seizure medication management. Therefore, continuous video EEG monitoring has important clinical management implications in neonates with a high risk of encephalopathy.

Maternal Serotonergic Antidepressant Use in Pregnancy and Risk of Seizures in Children.

Background and ObjectivesTo evaluate whether children born to women who use serotonergic antidepressants during pregnancy have higher risk of neonatal seizures and epilepsy.MethodsWe used Swedish register-based data to examine associations between maternal reported use of selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors (SNRIs) in pregnancy and diagnosis of neonatal seizures or epilepsy in >1.2 million children. To account for systematic differences between exposed and unexposed children, we adjusted for a wide range of measured confounders. After first evaluating the role of maternal indication for SSRI/SNRI use (i.e., depression or anxiety) and parental epilepsy, we adjusted for remaining parental background factors (e.g., age, comorbidities, education, and family socioeconomic indices) and pregnancy-specific characteristics (e.g., maternal use of other psychotropic medications and tobacco smoking in early pregnancy).ResultsCompared with all other children, children of women who reported use of SSRI/SNRI in pregnancy had an elevated risk of neonatal seizures and epilepsy (risk ratio [RR] 1.41, 95% CI 1.03–1.94; hazard ratio [HR] 1.21, 95% CI 1.03–1.43, respectively). The estimates of association were attenuated by adjustment for maternal indications for SSRI/SNRI use (RR 1.30, 95% CI 0.94–1.80; HR 1.13, 95% CI 0.95–1.33), but not by additional adjustment for parental history of epilepsy. Full adjustment for all measured parental and pregnancy-specific factors resulted in substantial attenuation of the remaining associations (RR 1.10, 95% CI 0.79–1.53; HR 0.96, 95% CI 0.81–1.14).DiscussionWe found no support for the concern that maternal SSRI/SNRI use in pregnancy increases children's risk for neonatal seizures or epilepsy.Classification of EvidenceThis study provides Class II evidence that exposure to SSRIs/SNRIs in the first trimester of pregnancy is not associated with an increased incidence of neonatal seizures/epilepsy.

Risk factors for seizures in the vigorous term neonate: A population-based register study of singleton births in Sweden.

BackgroundNeonatal seizures have been associated with increased mortality and impaired neurodevelopment and, knowledge about risk factors may be useful for prevention. Clear associations have been established between labor-related risk factors and seizures in asphyxiated neonates. However, there is limited information about why some vigorous term-born infants experience seizures.ObjectivesOur aim was to assess antepartum and intrapartum risk factors for seizures in vigorous term-born neonates.MethodsThis was a national cohort study of singleton infants born at term in Sweden from 2009–2015. Vigorous was defined as an Apgar score of at least 7 at 5 and 10 minutes. Data on the mothers and infants were obtained from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register. A diagnosis of neonatal seizures was the main outcome measure and the exposures were pregnancy and labor variables. Logistic regression analysis was used and the results are expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).ResultsThe incidence of neonatal seizures was 0.81/1,000 for 656 088 births. Seizures were strongly associated with obstetric emergencies (aOR 4.0, 95% CI 2.2–7.4), intrapartum fever and/or chorioamnionitis (aOR 3.4, 95% CI 2.1–5.3), and intrapartum fetal distress (aOR 3.0, 95% CI 2.4–3.7). Other associated intrapartum factors were: labor dystocia, occiput posterior position, operative vaginal delivery, and Cesarean delivery. Some maternal factors more than doubled the risk: a body mass of more than 40 (aOR 2.6, 95% CI 1.4–4.8), hypertensive disorders (aOR 2.3, 95% CI 1.7–3.1) and diabetes mellitus (aOR 2.6, 95% CI 1.7–4.1).ConclusionA number of intrapartum factors were associated with an increased risk of seizures in vigorous term-born neonates. Obstetric emergencies, intrapartum fever and/or chorioamnionitis and fetal distress were the strongest associated risks. The presence of such factors, despite a reassuring Apgar score could prompt close surveillance.

The Frequency of Clinical Seizures in Paroxysmal Events in a Neonatal Intensive Care Unit.

Background: In general clinical practice, neonatal seizures are identified visually by direct clinical observation. The study aimed to examine the frequency of clinical seizures in paroxysmal events in a neonatal intensive care unit. Methods: We conducted a prospective study of continuous video-EEG monitoring in a neonatal intensive care unit between January 2017 and December 2020. The demographic data were also reviewed. Results: Sixty-four neonates were enrolled. The median total video-EEG monitoring duration was 24.1 h (IQR 17.5–44.8 h). There were 309 clinically suspected seizure episodes, of which 181 (58.6%) were the motor type and 128 (41.4%) were the non-motor type. Only 63 (20.4%) of these events were confirmed to be clinical seizures on a simultaneous video-EEG recording. In terms of the impact of continuous video-EEG monitoring on clinical management, the anti-epileptic drugs were changed in 42 (65.6%) of the 64 neonates. Conclusion: In the identification of neonatal seizures, a clinical diagnosis by direct observation alone is not enough. The use of continuous video-EEG monitoring plays an important role in the diagnosis of neonatal seizures and in guiding clinical management decisions.

Current and Future Uses of Continuous EEG in the NICU.

Continuous EEG (cEEG) is a fundamental neurodiagnostic tool in the care of critically ill neonates and is increasingly recommended. cEEG enhances prognostication via assessment of the background brain activity, plays a role in predicting which neonates are at risk for seizures when combined with clinical factors, and allows for accurate diagnosis and management of neonatal seizures. Continuous EEG is the gold standard method for diagnosis of neonatal seizures and should be used for detection of seizures in high-risk clinical conditions, differential diagnosis of paroxysmal events, and assessment of response to treatment. High costs associated with cEEG are a limiting factor in its widespread implementation. Centralized remote cEEG interpretation, automated seizure detection, and pre-natal EEG are potential future applications of this neurodiagnostic tool.

Clinical manifestations of neonatal seizures.

Neonatal seizures present a unique diagnostic challenge with clinical manifestations often subtle or absent to the bedside observer. Seizures can be overdiagnosed in newborns with unusual paroxysmal movements and underdiagnosed in newborns without clinical signs of seizures. Electroclinical "uncoupling" also adds to the diagnostic challenge. Reliable diagnosis requires additional tools; continuous electroencephalogram (EEG) monitoring is the gold standard for diagnosis of neonatal seizures. Certain high-risk neonatal populations with known brain injury, such as stroke or hypoxic-ischemic encephalopathy, are most likely to benefit from continuous EEG. Studies have shown that risk stratification for continuous EEG has positive impact on care, including rapid and accurate diagnosis and treatment of neonatal seizures, which leads to reduced use of antiseizure medicines and length of hospital stay. This review describes common clinical manifestations of neonatal seizures, and clinical situations in which EEG monitoring to screen for seizures should be considered.

Neonatal Brain Injury From SARS-CoV-2: Fact or Fiction?

Neonatal Brain Injury From SARS-CoV-2: Fact or Fiction?

Multiparametric EEG analysis of brain network dynamics during neonatal seizures

BackgroundOne of the most challenging issues in paediatric neurology is the diagnosis of neonatal seizures, whose delayed treatment may affect the neurodevelopment of the newborn. Formulation of the correct diagnosis is conditioned by the high number of perceptually or automatically detected false positives. New MethodNew methodologies are proposed to assess neonatal seizures trend over time. Our approach is based on the analysis of standardized trends of two properties of the brain network: the Synchronizabilty (S) and the degree of phase synchronicity given by the Circular Omega Complexity (COC). Qualitative and quantitative methods based on network dynamics allow differentiating seizure events from interictal periods and seizure-free patients. ResultsThe methods were tested on a public dataset of labelled neonatal seizures. COC shows significant differences among seizure and non-seizure events (p-value <0.001, Cohen’s d 0.86). Combining S and COC in standardized temporal instants provided a reliable description of the physiological behaviour of the brain’s network during neonatal seizures. Comparison with Existing Method(s)Few of the existing network methods propose an operative way for carrying their analytical approach into the diagnostic process of neonatal seizures. Our methods offer a simple representation of brain network dynamics easily implementable and understandable also by less experienced staff. ConclusionsOur findings confirm the usefulness of the evaluation of brain network dynamics over time for a better understanding and interpretation of the complex mechanisms behind neonatal seizures. The proposed methods could also reliably support existing seizure detectors as a post-processing step in doubtful cases.

Современные нейрохимические и молекулярно-генетические аспекты патогенеза неонатальных судорог

The article is devoted to the modern aspects of the pathogenesis of neonatal seizures (NS). The main mechanisms of the development of perinatal brain injuries, which are fundamental in the genesis of NS, are considered, the prospects for research devoted to the study of the possibilities of molecular genetic prediction of the individual risk of ischemia and the development of NS are outlined. The mechanisms of ischemic brain damage during the neonatal period and the role of glutamate, the main excitatory neurotransmitter acting on NMDA receptors that regulate the electrical activity of neurons, are described in detail. The review focuses on the involvement of metalloproteinases, primarily MMP-9, which destroys type IV collagen, which is the main component of the basement membrane of the cerebral endothelium, and creates conditions for cell migration across the BBB, thereby causing a cytokine storm and the development of inflammation, leading to NS. The possible role of calcium-dependent proteinases — calpains in the development of NS is analyzed, since in some forms of CNS pathology, uncontrolled hyperactivation of calpains is observed, leading to a disruption of the regulation of neurotransmitter transmission, which can, in turn, become an additional factor for the development of the neurodegenerative process in the brain and the development of seizures. Also are presented the results of studies devoted to the role of ion channels, providing synaptic transmission of excitation from an excited neuron to other cells. It has been shown that molecular defects in ion channels can be one of the factors that create prerequisites for the development of NS. The article shows the prospects for studying the genetic polymorphism of enzymes involved in the pathogenesis of ischemic brain damage, based on ideas about the pathogenesis of cerebral disorders in newborns, which are based on oxidative damage. The concluding part of the article outlines the modern principles of NS therapy, their main goal is to relieve the symptoms of the underlying disease, to ensure the normalization of blood circulation and brain metabolism, to optimize the conditions for the functioning of the preserved brain structures to prevent the formation of severe neurological complications, as well as to maintain optimal parameters of respiration, glucose-electrolyte composition of blood and thermal regime. Based on the data presented, it is concluded that early diagnosis of NS is necessary, which is determined by the fact that seizures in newborns are usually caused by serious damage to the child's brain, and in some cases — by life-threatening conditions, the timely diagnosis of which contributes to the early onset of specific treatment. No conflict of interest was declared by the author. Key words: newborn, cerebral ischemia, neonatal seizures.

Incontinentia pigmenti: a rare case of neurocutaneous disorder in the newborn

Incontinentia pigmenti (IP) is a rare X linked dominant genetic multisystem neurocutaneous disorder that may affect many organs including the skin, bone, eyes and the central nervous system. Central nervous system manifestations are seen in 30%-40% of cases with seizures and mental retardation. Seizures as the presenting sign of IP in neonates are rarely reported. We report a case of a female newborn with IP who had pleomorphic skin rashes and erythematous vesicles over upper and lower extremities since 5th day of life which were followed by seizures on day 22nd of life. With this case report, we would like to emphasize the need for inclusion of IP in the differential diagnosis of neonatal seizures and to confirm diagnosis of all such unusual skin lesions histologically.

A machine-learning algorithm for neonatal seizure recognition: a multicentre, randomised, controlled trial

SummaryBackgroundDespite the availability of continuous conventional electroencephalography (cEEG), accurate diagnosis of neonatal seizures is challenging in clinical practice. Algorithms for decision support in the recognition of neonatal seizures could improve detection. We aimed to assess the diagnostic accuracy of an automated seizure detection algorithm called Algorithm for Neonatal Seizure Recognition (ANSeR).MethodsThis multicentre, randomised, two-arm, parallel, controlled trial was done in eight neonatal centres across Ireland, the Netherlands, Sweden, and the UK. Neonates with a corrected gestational age between 36 and 44 weeks with, or at significant risk of, seizures requiring EEG monitoring, received cEEG plus ANSeR linked to the EEG monitor displaying a seizure probability trend in real time (algorithm group) or cEEG monitoring alone (non-algorithm group). The primary outcome was diagnostic accuracy (sensitivity, specificity, and false detection rate) of health-care professionals to identify neonates with electrographic seizures and seizure hours with and without the support of the ANSeR algorithm. Neonates with data on the outcome of interest were included in the analysis. This study is registered with ClinicalTrials.gov, NCT02431780.FindingsBetween Feb 13, 2015, and Feb 7, 2017, 132 neonates were randomly assigned to the algorithm group and 132 to the non-algorithm group. Six neonates were excluded (four from the algorithm group and two from the non-algorithm group). Electrographic seizures were present in 32 (25·0%) of 128 neonates in the algorithm group and 38 (29·2%) of 130 neonates in the non-algorithm group. For recognition of neonates with electrographic seizures, sensitivity was 81·3% (95% CI 66·7–93·3) in the algorithm group and 89·5% (78·4–97·5) in the non-algorithm group; specificity was 84·4% (95% CI 76·9–91·0) in the algorithm group and 89·1% (82·5–94·7) in the non-algorithm group; and the false detection rate was 36·6% (95% CI 22·7–52·1) in the algorithm group and 22·7% (11·6–35·9) in the non-algorithm group. We identified 659 h in which seizures occurred (seizure hours): 268 h in the algorithm versus 391 h in the non-algorithm group. The percentage of seizure hours correctly identified was higher in the algorithm group than in the non-algorithm group (177 [66·0%; 95% CI 53·8–77·3] of 268 h vs 177 [45·3%; 34·5–58·3] of 391 h; difference 20·8% [3·6–37·1]). No significant differences were seen in the percentage of neonates with seizures given at least one inappropriate antiseizure medication (37·5% [95% CI 25·0 to 56·3] vs 31·6% [21·1 to 47·4]; difference 5·9% [–14·0 to 26·3]).InterpretationANSeR, a machine-learning algorithm, is safe and able to accurately detect neonatal seizures. Although the algorithm did not enhance identification of individual neonates with seizures beyond conventional EEG, recognition of seizure hours was improved with use of ANSeR. The benefit might be greater in less experienced centres, but further study is required.FundingWellcome Trust, Science Foundation Ireland, and Nihon Kohden.

A clinico-etiological evaluation and EEG correlation of neonatal seizures in a tertiary care hospital: a prospective cohort study

Background: Neonatal seizure is defined as a paroxysmal alteration in neurological function. The diagnosis of neonatal seizures is difficult to establish because of varied etiologies involved. The incidences vary from 1.5-3.7/1000 live births in term babies.Methods: Hospital based observational study was conducted from December 1, 2016 till March 31, 2018. Universal sampling technique was followed. 93 neonates fulfilling the inclusion criteria were included in the study after consent from parents.Results: This study results showed that 60.2% were males. Pre-term delivery occurred in 12.9% neonates. Most common etiology of neonatal seizures was birth asphyxia with 47.3% followed by metabolic abnormalities 32.3%. Abnormal EEG pattern was seen in 29% cases of neonatal seizures.Conclusions: To conclude, the most common aetiology for neonatal seizures was birth asphyxia followed by metabolic abnormalities in which hypoglycaemia was the most common type. A significant association of seizures due to meningitis and metabolic abnormalities was observed with pre-term gestation while abnormal EEG pattern was observed with birth asphyxia and meningitis. EEG findings were found normal in majority of cases of neonatal seizure.

A clinico-etiological evaluation of neonatal seizures in a tertiary care hospital: a prospective cohort study

Background: Neonatal seizure is defined as a paroxysmal alteration in neurological function. The diagnosis of neonatal seizures is difficult to establish because of varied etiologies involved. The incidences vary from 1.5-3.7/1000 live births in term babies.Methods: Hospital based observational Study was conducted from December 1, 2016 till March 31, 2018. Universal sampling technique was followed. 93 neonates fulfilling the inclusion criteria were included in the study after consent from parents.Results: Present study results showed that 60.2% were males. Pre-term delivery occurred in 12.9% neonates. Most common etiology of neonatal seizures was birth asphyxia with 47.3% followed by metabolic abnormalities 32.3%.Conclusions: The most common etiology for neonatal seizures was birth asphyxia followed by metabolic abnormalities in which hypoglycaemia was the most common type. A significant association of seizures due to meningitis and metabolic abnormalities was observed with pre-term gestation.

Association Between Neonatal Seizures and Social-Emotional Development and Adaptive Behavior in Extremely Low Birth Weight Infants.

To evaluate social-emotional development and adaptive behavioral outcomes in a cohort of extremely low birth weight infants with a confirmed diagnosis of neonatal seizures. This is a retrospective cohort study of preterm infants weighing ≤1000 g at birth, with a diagnosis of neonatal seizures, evaluated between 21 and 31 months of age using the Bayley Scales of Infant Development (Bayley-III) in a longitudinal neurodevelopmental follow-up program. Seizures were diagnosed using continuous video electroencephalography interpreted by a pediatric neurologist. Nineteen infants meeting criteria were included and were matched with 38 control subjects, without clinical signs of seizures, and similar baseline characteristics. Multivariate analysis revealed significantly lower social-emotional development (-14.8 points; P = .05) and adaptive behavior scores (-10.8 points; P < .01) on the Bayley III in children with seizures compared to controls without clinical signs of seizure.Interpretation: Seizures are associated with impaired adaptive behavior and social-emotional development in this cohort of extremely low birth weight infants. These results highlight the negative association between neonatal seizures and functional development.

Lack of response to treatment with levetiracetam in extreme preterm infants with seizures.

The aim of this study was to evaluate the effectiveness of monotherapy with levetiracetam (LEV) in achieving seizure cessation in a retrospective cohort of extreme preterm infants with seizures. Charts of infants with a diagnosis of neonatal seizures admitted to the NICU between 2013 and 2017 were reviewed. Seizures were diagnosed using continuous video electroencephalography. All infants were initially started on LEV and reached a dose of 80 mg/kg/day. Other ASMs were added to LEV if seizures continued after 2 days. Data on additional clinical variables were collected for each infant. Sixty-one infants born <28 weeks of gestation met inclusion criteria. Seventy-four percent of patients did not respond to LEV monotherapy and required additional medications. LEV monotherapy stopped seizures in only a small portion of cases.

Neonatal Encephalopathies: A Clinical Perspective.

Seizures are the most acute evident manifestation of central nervous system dysfunction in neonates. The incidence is higher in very low weight neonates, about 58/100 live births, as opposed to full-term infants, estimated about 3.5/100 live births. Neonatal seizures represent the clinical manifestation of a non-specific disorder of cortical cerebral dysfunction, which could lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment of each clinical scenario. The diagnosis and its management are further complicated as most neonatal seizures may have very subtle or no clinical changes and the diagnosis may be just based on EEG findings, so-called subclinical. The treatment is dependent on the etiology, but early and opportune intervention can prevent further brain damage and improve prognosis. Although early identification and treatment are essential, the diagnosis of neonatal seizures can be further complicated by the clinical presentations, possible etiologies, and treatments. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.

S53 AED development in neonates

Seizures are the most common neurological emergency in the neonatal period and associated with considerable mortality and morbidity. Neonatal seizures are usually acute and are often subclinical or show discreet clinical manifestations that are often difficult to differentiate from movements seen in sick preterm or term babies. Hence, the need for EEG confirmation for the diagnosis of neonatal seizures is now widely accepted. All of this makes the integration into a classification serving all ages difficult, which is reflected by the fact that, until recently, the ILAE classifications did not include neonatal seizures. Consequently other classifications have been published by neonatologists and paediatric neurologists, which are specific to the neonatal period (Volpe, 1989; Mizrahi and Kellaway, 1987). In 2014, a new Task Force on Neonatal Seizures has been established which aims to develop ways in which neonatal seizures and epilepsies can be integrated into the new classification of the epilepsies. We have developed a diagnostic framework to describe neonatal seizures which can be used in conjunction with the new classification of the epilepsies using the same concepts and terminology. The framework will be presented with video examples of all seizure types.

Case 1: Seizures and Rashes Do Run in the Family

A term female infant is born by spontaneous delivery at 40 2/7 weeks’ gestational age with a birthweight of 3,560 g (50th percentile) and a head circumference of 34.5 cm (50th percentile) to a 25-year-old primigravida. The parental history and the course of the present pregnancy are unremarkable. The infant is born by spontaneous normal vaginal delivery. Her Apgar scores are 8 and 10 at 1 and 5 minutes, respectively. At the age of 43 hours, tonic-clonic movements of the right hand and leg are observed, during which she is completely conscious. The physical examination reveals an erythematic rash on the lower abdomen and lower limbs, which appear and fade (Fig 1), and a small area of alopecia on the right parietal side of the head (Fig 2). The rest of the physical examination findings are normal. Under a presumed diagnosis of neonatal seizures, both basic and extended investigations are undertaken, including infectious, metabolic, hematologic, and endocrinologic tests. Broad-spectrum antibiotics and acyclovir are initiated. The focal seizures worsen, become generalized, and are accompanied by episodes of apnea, deep desaturation, and bradycardia. They cease after second-line levetiracetam is added to the initial phenobarbital treatment. A single dose of pyridoxine (vitamin B6) is also given, with no change in the clinical condition. Figure 1. Nonspecific erythematic rash on lower limbs and lower abdomen at presentation. Figure 2. Small area of alopecia on the right parietal side of the head at presentation. The complete blood cell count and the C-reactive protein levels are normal, as are the blood and cerebrospinal fluid (CSF) chemistries. Blood gases, basic …

Etiological and clinical profile of neonatal seizures in a highly consanguineous population

A prospective longitudinal study was conducted on all neonates admitted with a diagnosis of neonatal seizures in the neonatal intensive care unit of Jordan University Hospital Amman from April 2003 to March 2005 to examine the cause and clinical profile of seizures in a community, which culturally favors consanguineous marriages. Of 35 neonates studied, inborn errors of metabolism accounted for 28.6%, hypoxic ischemic encephalopathy for 17.1% and cerebral malformations for 14.3%. The consanguinity rate among parents of affected neonates was 54%, and 22.9% of these probands had a similarly affected sibling. Compared with 78 matched controls, consanguinity proved to be a risk factor for neonatal seizures (P=0.007, odds ratios =3.02; 95% confidence intervals 1.22 to 7.51). The hospital-based incidence of seizures was 5.6 per 1000 live births. Poor outcome in the form of mortality or morbidity was present in 67.8% of the cases. Early-onset seizures and status epilepticus accounted in 40% and 22.9% of cases respectively, with subtle seizures being the commonest type. Based on our results, inborn errors of metabolism and cerebral malformations make a significant contribution to the etiology of clinical neonatal seizures. This is accounted for by the consanguineous population being at risk for a number of neurogenetic disorders leading to convulsions on one hand and by improved methods of diagnosis of neonatal seizures on the other. In future, genetic counseling may help to minimize the contribution of underlying genetic factors to neonatal seizures in our community.