Neonatal Seizures

Characteristics
Neonatal seizures are quite different from the
seizures that occur in older children and adults. Seizures in neonates are
often fragmentary and most of them are for a short span, lasting for a few
days. They are relatively common, with variable clinical manifestations.
However, seizures are more often an indication of serious neurological
malfunction and might also predict long- term cognitive and developmental
damage.
Symptoms
Identification of neonatal seizures is very
difficult, yet critical. Even normal babies exhibit sudden brief jerky
movements (The Moro reflex), jitters, glares and certain mouth
movements which are quite similar to behaviour of infants with seizures.
An affected baby may have jerking/stiffening of his
extremities that can alternate from one side to the other, or may involve the
whole of upper body. It could be accompanied by change in facial expressions,
breathing, and heart rate. Although, absence of response in newborn is crucial
in the diagnosis of seizures, it is often unnoticed by parents.
Subtle seizures are more common in full- term babies
as compared to premature infants.
A video on Neonatal Seizures
Diagnosis
Neonatal Convulsions is one the very few
neurological emergencies that requires urgent diagnosis and management. An
epileptic diagnosis is suspected if –
- Neonatal behaviour is not typical of children in the same age group.
- Recurring episodes of abnormal behaviour and in a set pattern and duration.
- Stereotypic behaviour while the child is sleeping or awake.
- Episodes do not stop by any change in posture, activity or gentle manipulation of extremities.
Classification
Clonic seizures
Clonic seizures
often manifest with stiffness in one
extremity or on one side of the body. The frequency is usually slow, ranging at
1-3 movements/second.
Tonic seizures
They
are characterised by tonic extension of hands and legs along with involment of facial
muscles.
Myoclonic seizures
Focal
myoclonic seizures are present in one extremity. When many body parts are
involved, it is referred to as multifocal myoclonic seizure.
Management and Treatment
Underlying cause of the neonatal
seizures of metabolic disturbances should be cured accordingly rather than
treating them with anti-epileptic medication. Physicians and experts follow different
drugs for the treatment of neonatal seizures and the practice is highly
empirical. Some effective antiepileptic drugs( AED) commonly used in neonates
are Phenobarbitone and phenytoin, Fosphenytoin and Benzodiazepines.
A larger dose in the starting, followed
by a regular dose of AED is recommended. Absence of any repeated episodes of
seizures and a normal EEG report later, may encourage discontinuation of the
treatment.
Comments
Post a Comment