Etiology Of Neonatal Seizures Research Articles

Clinical profile and etiology of neonatal seizures in NICU Rims, Raichur

Introduction: Seizures are more common in the neonatal period than in any other stage and affects approximately 1% of all neonates. Amongst neurological disorders, seizures are the most common in neonates. The study was conducted to determine the aetiology and clinical profile of neonatal seizures. Materials and Methodology: This study was designed to be a hospital based prospective observational study was undertaken in the in the hospital attached neonatal intensive care unit (NICU), RIMS, Raichur. A total of 500 neonates presenting with seizures or who developed seizures in hospital from 01 February 2022 to 31 May 2022 were enrolled in the study. All neonates (age 0 – 28 days) who presented to the hospital with history of seizures or who develop seizures during the course of hospital stay were taken into study. Detailed antenatal history examination and clinical details of each seizure episode reported by the mother and subsequently observed by the resident doctors on duty were recorded. Results: Among these 405 patients (81%) were from rural areas and 95 patients (19%) were from urban areas.

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.

A study of neonatal seizures in view of a etiology onset type and clinical manifestations

Introduction: Neonatal seizures are significant because most of them are treatable if a specific cause is identified. Prompt diagnosis is important to plan correct treatment. The time of onset of seizures is closely related to the aetiology of seizure Objectives: The objective of the present study is to know the etiology of seizures, the time of onset, relation to the cause and the common types of seizures Methodology: 102 neonates presenting with seizures admitted in the NICU of RMH, Thanjavur Medical College, Thanjavur during January 2014 to august 2014 were taken for study, Detailed antenatal, natal and post natal history were taken and examination of baby done and HIE staged according to Modified Sarnat’s staging. Then relevant investigations were done and etiology of neonatal seizures were diagnosed and staged Results: In the present study, out of 102 neonates studied, 82 were full-term, among these 60 (58.8%) were AGA and 22 (21.6%) were SGA. 19 babies (18.6%) were preterm. Male: Female ratio in our study was 1.5:1. Conclusion: The most common etiology for neonatal seizures is HIE. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Subtle seizures is the commonest type of seizures and is difficult to identify. Keywords: Neonatal seizures; Birth asphyxia; HIE; Subtle seizures; Hypoglycemia

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.

Evaluation of the Neonate with Seizures.

Neonatal seizures are common, occurring in 2 to 5 of 1,000 live births in the United States. The neonatal brain is thought to be predisposed toward seizures due to a combination of excessive excitatory and deficient inhibitory neuronal activity. The seizures tend to be focal or multifocal without secondary generalization, resulting in subtle seizure appearance. There are five main categories of neonatal seizures: focal clonic, focal tonic, myoclonic, subtle, and generalized tonic. An electroencephalogram is recommended to diagnose and treat neonatal seizures due to poor reliability of the clinical examination. Causes of neonatal seizures are broad, including trauma, structural brain anomalies, infections, metabolic disorders, drug withdrawal or intoxication, and neonatal epilepsy syndromes. Treatment of neonatal seizures involves management of cardiorespiratory status, correction of metabolic derangements, and antiepileptics as needed. The most common antiepileptics used in neonates are phenobarbital, levetiracetam, and fosphenytoin. The long-term risk of neurodevelopmental disability varies depending upon the etiology of neonatal seizures. Close attention to developmental milestones and neurology follow-up is recommended for all neonates with seizures. [Pediatr Ann. 2020;49(7):e292-e298.].

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.

The etiology of neonatal seizures in the specialized perinatal center

The etiology of neonatal seizures in the specialized perinatal center

AN OBSERVATIONAL STUDY OF VARIOUS CLINICAL PRESENTATIONS OF NEONATAL SEIZURES WITH THEIR RELATIVE FREQUENCY AND THEIR CORRELATION WITH ETIOLOGY.

The study has been conducted in the neonatal unit of IMCHRC Indore Madhya Pradesh. This is a tertiary care teaching hospital.
 Overall most common etiology of neonatal seizures in our study was sepsis (64.9%), followed by birth asphyxia 48.3% cases, hypoglycemia (25%) & hypocalcaemia (21.6%)
 Birth asphyxia is the most common cause of subtle seizures and sepsis led to tonic seizures.
 The most common aetiology for neonatal seizures is sepsis. This is because the study was conducted in a Medical college placed in rural area, in which patients are coming from villages and rural background, where concept of hygiene is poor, so source of infection was higher. Patients of Birth Asphyxia are less, since our hospital is of tertiary care level where inborn patients are given good perinatal care. Due to lack of knowledge & awareness of infant feeding we got cases of hypoglycaemia& electrolyte imbalance. Onset of seizures during first 3 days of life has significant correlation with HIE as aetiology. Most of the newborn are term & male preponderance was found. Subtle seizures are commonest type of clinical seizures, which were difficult to identify, therefore careful observation of at risk newborns is necessary.
 Keywords: Clinical, Seizures, Neonates & Etiology.

Etiology of neonatal seizures and maintenance therapy use: a 10-year retrospective study at Toulouse Children\u2019s hospital

BackgroundNo guidelines exist concerning the maintenance antiepileptic drug to use after neonatal seizures. Practices vary from one hospital to another. The aim of this study was to investigate etiologies and to report on the use of maintenance antiepileptic therapy in our population of full-term neonates presenting neonatal seizures.MethodsFrom January 2004 to October 2014, we retrospectively collected data from all full-term neonates with neonatal seizures admitted to the Children’s Hospital of Toulouse, France.ResultsTwo hundred and forty-three neonates were included (59% males, 48% electroencephalographic confirmation). The frequencies of etiologies of neonatal seizures were: hypoxic-ischemic encephalopathy (HIE) (n = 91; 37%), ischemic infarction (n = 36; 15%), intracranial hemorrhage (n = 29; 12%), intracranial infection (n = 19; 8%), metabolic or electrolyte disorders (n = 9; 3%), inborn errors of metabolism (n = 5; 2%), congenital malformations of the central nervous system (n = 11; 5%), epileptic syndromes (n = 27; 12%) and unknown (n = 16; 7%). A maintenance therapy was prescribed in 180 (72%) newborns: valproic acid (n = 123), carbamazepine (n = 28), levetiracetam (n = 17), vigabatrin (n = 2), and phenobarbital (n = 4). In our cohort, the choice of antiepileptic drug depended mainly on etiology. The average duration of treatment was six months.ConclusionsIn our cohort, valproic acid was the most frequently prescribed maintenance antiepileptic therapy. However, the arrival on the market of new antiepileptic drugs and a better understanding of the physiopathology of genetic encephalopathies is changing our practice.Trial registrationRetrospectively registered. Patient data were reported to the “Commission Nationale Informatique et Libertés” under the number 2106953.

Clinical Profile and Etiology of Neonatal Seizures in a Tertiary Care Hospital in North India

Clinical Profile and Etiology of Neonatal Seizures in a Tertiary Care Hospital in North India

Etiology and Short Term Outcome of Neonatal Convulsion in NICU at Benghazi Children Hospital

Background: Neonatal seizures are the most prominent feature of neurological dysfunction during neonatal period, which are abnormal electrical discharges in the central nervous system of neonates, usually manifest as stereotyped muscular activity or autonomic changes, occurring in approximately 1.8 - 3.5/1000 live birth. Objective: The aims of study are to determine prevalence rate, natural history, time of onset, etiological factors, clinical types and the short term outcome of neonatal convulsion. Settings: This study conducted in Neonatal Department at Benghazi Children Hospital—Libya. Patients and Methods: Descriptive cross sectional study, included all neonates who developing clinically identifiable seizures, admitted from 1st of March 2013 to 1st of March 2014. The data collected by using a designed perform including; gender, nationality, residence, place of transfer, gestational age, time of onset, mode of delivery, and history of maternal diseases, family history of neonatal seizures in previous siblings or death, jaundice and exchange transfusion were taken. Details examination include dysmorphic features, weight, head circumference were recorded. Types of seizures were diagnosed by clinical observations, and the etiology of neonatal seizures had been identified from imaging study and from initial relevant investigations which include blood glucose levels, arterial blood gases, serum calcium, electrolytes, phosphate and cerebrospinal fluid examination for evidence of infection. In addition to treatments received, as well as causes of deaths. Results: A total of 2842 neonates were admitted to NNW, out of which 150 had seizures. 86 (57%) were male with M:F ratio of 1.3:1. (97%) were Libyan and (76%) from Benghazi, (42%) admitted directly from home. 131 (87%) were term and 15 (10%) preterm. Most of neonatal seizures (76%) were seen in the 1st week of life, and during initial 72 hours of life (63%), with 24% presented in 1st 24 hours of life. Vaginal delivery conducted in 101 (67%), C/S 49 (33%). Among babies with birth asphyxia, 76% delivered vaginally. 43/150 mothers presented with different medical problems, 32% of them had preeclampsia followed by diabetes in 28%. 127 (85%) babies had normal birth weight and 128 (86%) lie within normal range of head circumference. The most common type of seizure was subtle (48%) followed by clonic (36%). Cranial ultrasound performed to 110 (73%), among them, 16 babies MRI or CT scan were done. The most common cause of seizure was birth asphyxia (30%) followed by infection (16%), hypocalcemia (14%). Phenobarbitone was the most common drug used in treatment (60%), followed by phenytoin (40%) and resistant cases for treatment received pyridoxine (2%). 77 (52%) improved and discharged home without treatment. Mortality rate was 15%; among them 44% from IEM, followed by birth asphyxia 22%. There is strong association between main causes and the outcome with p = 0.005. Conclusion: The majority of neonates in our study were full term and male. The most common etiology of seizures is birth asphyxia. Hypocalcemia is the most common biochemical abnormality. Subtle represents the commonest type of seizure. Phenobarbitone is still the most commonly prescribed anticonvulsant. Inborn error of metabolism carries a higher mortality rate. Statically analysis showed there is significant association between main causes of neonatal convulsions and the outcome with p = 0.005.

NEONATAL SEIZURES IN INFANTS OF DIFFERENT GESTATIONAL AGE

Main etiologies of neonatal seizures (NS) were evaluated among 165 newborns of different gestational age (GA). Neonates suffered NS were subdivided into four groups: I - 84 early preterm newborns with GA 28 weeks and less, II - 52 with GA 29-32 weeks, III - 12 newborns with GA 33-36 weeks and IV - 17 term infants with GA between 37 and 41 wks. Complex clinical and instrumental assessment of 165 infants determined the following etiologies of NS: perinatal hypoxia-ischemia in 72.1% of cases, intracranial hemorrhage grade III-IV in 6.1%, congenital infections in 9.7%, CNS infections (bacterial meningitis and viral meningoencephalitis) in 9.7%, сerebral dysgenesis in 1.2% and inborn errors of metabolism and neurodegenerative diseases accounted for 1.2%. Intracranial hemorrhage grade III-IV was only registered in newborns with GA less than 32 wks. The role of CNS infections increased in term newborns (23.5%). Possibility of genetic etiologies should be taken into consideration while investigating newborns with NS, mainly when the possible early brain damage causes are absent. This is of great importance because the potentials of targeted therapies for epileptic syndromes due to genetic conditions are increasing nowadays. Perspectives of levetiracetam use in infants with NS and early onset forms of epilepsy were discussed.

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

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

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

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

T87. EEG and simultaneously recorded SEPs in evaluation of newborns with hypoxic ischemic encephalopathy or stroke in the NICU

Introduction Differential diagnostics and outcome prediction in newborns presenting with seizures or encephalopathy remain difficult in the bedside. The objectives of the present study were (i) to determine the accuracy of simultaneously recorded EEG and somatosensory evoked potentials (SEPs) in differentiating between hypoxic-ischemic encephalopathy (HIE) and stroke as the underlying etiology of neonatal seizures or encephalopathy and (ii) to determine the accuracy of EEG and SEPs and their combination for predicting outcome in newborns with HIE or stroke. Methods The study comprised of 133 newborns (gestational age > 34 weeks) that underwent a clinically indicated EEG and simultaneous SEPs in the acute phase of their illness. 102 of the newborns had HIE and 31 had stroke. EEG background was scored as continuous (sleep stages identifiable and EEG continuous at least in active sleep or awake state) or discontinuous (sleep stages not identifiable and EEG not continuous at any time during the recording). The SEPs were classified as bilaterally absent, unilaterally absent, or bilaterally present. Outcome was evaluated from medical records at approximately 1–1.5 years age. Death, cerebral palsy, severe mental retardation, and epilepsy were considered as unfavorable outcomes. Normal or mildly abnormal development (e.g. mild motor or language delay) were considered as favorable outcomes. Results The combinations of EEG and SEP abnormalities were indicative of etiology (HIE vs stroke) and predictive of outcome. If the EEG was discontinuous, the etiology was always HIE (33 newborns) regardless of SEPs. Furthermore, if the EEG was continuous, but SEPs were uni- (9 newborns) or bilaterally (1 newborn) absent, the etiology was always stroke. Normal SEPs and continuous EEG occurred in 69 newborns with HIE and 21 newborns with stroke, and hence in these newborns the distinction between the etiologies could not be made with the present EEG-SEP criteria. This combination was, however, highly predictive of a favorable outcome regardless of the etiology: The outcome was favorable in 67/69 of those HIE and 20/21 of those with stroke. On the contrary, bi- or unilaterally absent SEPs were associated with poor outcome in all newborns with HIE (22/22) and all but two newborns with stroke (8/10). Furthermore, in newborns with HIE, even if the EEG was discontinuous but SEPs were bilaterally present, the outcome was likely to be favorable (8/11 newborns). Conclusion EEG-SEP is useful in bedside differential diagnostics between HIE and stroke in newborns presenting with seizures or general signs of encephalopathy. Furthermore, EEG-SEP is accurate in outcome prediction in both etiologies.

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

Neonatal seizures: clinical manifestations and etiology

Background Neonatal seizures or fits are signs of central ner-vous system (CNS) diseases, metabolic disorders, or other dis-eases disrupting the CNS. Neonatal seizures are poorly classi-fied, under-recognized and often difficult to treat. It is important torecognize the type of neonatal seizures that might be the only signof a CNS disorder.Objective To recognize the type and etiology of neonatal sei-zures in several hospitals in Jakarta.Methods This was an observational case series study on full-termand preterm infants who had seizures during hospitalization in CiptoMangunkusumo, Harapan Kita, and Fatmawati Hospitals betweenJanuary-June 2005. Neonatal seizures were defined as seizuresoccurring in the first 28 days of life of a term infant or 44 completedweeks of the infant’s conception age of preterm infant.Results There were 40 neonates who born within the study periodand had seizures. Girls were outnumbered boys. Most neonateswere full-term with birth weight of more than 2500 grams. Analy-ses were done on 38 neonates with epileptic and non-epilepticseizures, while the other two who had mixed clinical manifestationwere not included. Most seizures occurred in the first 3 days of life(23/38). The most common type was focal clonic (12/14) followedby general tonic (11/24) and motor automatism or subtle (10/24).The most common etiology was hypoxic ischemic encephalopa-thy (HIE) (19/38) followed by metabolic disturbances, mainly hy-pocalcaemia (11/38).Conclusion Common types of seizures in neonates were focalclonic, general tonic, and motor automatism (subtle). The mostcommon etiology was HIE followed by metabolic disturbances,mainly hypocalcaemia

Neonatal Seizures: Impact on Neurodevelopmental Outcomes.

Neonatal period is the most vulnerable time for the occurrence of seizures, and neonatal seizures often pose a clinical challenge both for their acute management and frequency of associated long-term co-morbidities. Etiologies of neonatal seizures are known to play a primary role in the anti-epileptic drug responsiveness and the long-term sequelae. Recent studies have suggested that burden of acute recurrent seizures in neonates may also impact chronic outcomes independent of the etiology. However, not many studies, either clinical or pre-clinical, have addressed the long-term outcomes of neonatal seizures in an etiology-specific manner. In this review, we briefly review the available clinical and pre-clinical research for long-term outcomes following neonatal seizures. As the most frequent cause of acquired neonatal seizures, we focus on the studies evaluating long-term effects of HIE-seizures with the goal to evaluate (1) what parameters evaluated during acute stages of neonatal seizures can reliably be used to predict long-term outcomes? and (2) what available clinical and pre-clinical data are available help determine importance of etiology vs. seizure burdens in long-term sequelae.

Prevalence of Stroke in Neonates Who Admitted With Seizures in Neonatal Intensive Care Unit.

Prevalence of neonatal stroke has been reported 1/2300-1/4000 live births and accounts for 12-20% of the cases of neonatal seizures. Although stroke has been introduced as the second cause of the neonatal seizures in literatures, it may remain unclear in diagnostic evaluations of seizure in neonates. This study was performed to assess the prevalence of stroke in neonates with seizure. In this cross-sectional study, all neonates ≥ 28 weeks of gestation with a diagnosis of seizures admitted to the NICU of Boo-Ali Sina Hospital in Sari, north of Iran, were enrolled. Brain CT scan and a Transcranial Doppler ultrasonography were performed for the all cases. In cases that stroke were reported in one or two above modalities, an MRI was also performed and prevalence of stroke was reported. Putative risk factors of stroke were analyzed with univariate and multivariate statistical methods. From 174 newborn infants, 75.3% of neonates were male. Prevalence of stroke was 8%, 2.3% and 3.4% in Doppler ultrasonography, CT scan and MRI reports respectively. Umbilical venous catheterization was the risk factor of stroke in the univariate and multivariate analysis (P= 0.001; OR, 10.39; 95% CI, 2.72- 39.77). The most common form of seizure was focal clonic seizures (78.6%) in neonates with stroke. Investigation of stroke as an etiology of neonatal seizures is essential because seizure may be the only symptom of neonatal cerebral infarction. Doppler ultrasonography can be a valuable diagnostic tool at first in critically ill neonates or in situations that MRI is not available primarily. Further studies with notice to outcome assessment of these infants recommended.