Your SlideShare is downloading. ×
Neonatal Seizures
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Neonatal Seizures

2,352
views

Published on

Published in: Health & Medicine, Sports

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,352
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
219
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Transcript

    • 1. Neonatal Seizures Amy Kao, M.D. Division of Neurology Doernbecher Children’s Hospital
    • 2. Objectives
      • Review the clinical presentation and differential diagnosis
      • Discuss pathophysiologic implications on clinical presentation
      • Review etiology
      • Apply this information to evaluation and treatment
      • Discuss prognosis
    • 3. Clinical Classification
      • Focal/Multifocal Clonic
        • Not generalized
        • Migratory
        • Not necessarily focal etiology
      • Focal Tonic
        • Not usually generalized
      • Generalized Myoclonic
    • 4. Clinical Classification
      • Subtle (“Hypomotor”)
        • Motor activity arrest
        • Apnea
        • Eye deviation
        • Autonomic changes
      • Motor automatisms
        • Oral-buccal-lingual movements
        • Swimming
        • Bicycling
    • 5. The Definition of a Seizure
        • “ paroxysmal discharge of cerebral neurons sufficient to cause clinically detectable events that are apparent either to the subject or to an observer”
    • 6. Definition of a Seizure in a Neonate?
      • Excitatory activity predominates
      • No paroxysmal discharge on EEG?
        • True seizure
          • The cortex is undeveloped
          • Deeper origin
        • “ Brainstem release phenomena”
    • 7. Definition of a Seizure in a Neonate…
      • Clinically detectable events?
        • Subtle
        • Truly only electrographic
          • Iatrogenic paralysis
          • High doses AEDs
          • Encephalopathy or subcortical/spinal cord damage
    • 8. If It Isn’t a Seizure, Then What Is It??
      • Possible clues
        • Stimulus-induced
        • Suppressable
        • No associated autonomic changes (usually not bradycardia)
    • 9. W eird B aby M ovements
        • Jitteriness
          • Stimulus-sensitive
          • “ Tremor”
          • Suppressable
        • Benign neonatal sleep myoclonus
        • Spinal myoclonus
        • Apnea of non-neurologic etiology
          • bradycardia
    • 10. Causes of Neonatal Seizures
      • Within first 24 hours of life
        • Hypoxic ischemic encephalopathy
        • Meningitis/sepsis
        • Subdural/Subarachnoid/Interventricular hemorrhage
        • Intrauterine infection
        • Trauma
        • Pyridoxine dependency
        • Drug effect/withdrawal
    • 11. Causes….
      • 24-72 hours
        • Meningitis/sepsis
        • In premature infants: IVH
        • In full-term infants: infarction, venous thrombosis
        • Cerebral dysgenesis
    • 12. Causes….
      • 72 hours to 1 week
        • Above causes
        • Inborn errors of metabolism
        • Hypocalcemia
        • Familial neonatal seizures
      • 1 week to 4 weeks
        • Above causes
        • HSV
    • 13. Other Syndromes
      • Benign idiopathic neonatal convulsions (BINC or Fifth-day fits)
      • Benign familial neonatal convulsions (BFNC)
      • Early myoclonic encephalopathy (EME)
      • Early infantile epileptic encephalopathy (EIEE)
      • Glucose transporter type I
    • 14. Evaluation of Neonatal Seizures
      • Serum lytes (gluc, Ca, Mg, Na)
      • CSF
      • Head ultrasound
      • EEG (B6?)
      • Tox screen
      • CT or MRI of brain
      • ?metabolic w/u, congenital infection w/u
    • 15. Treatment of Electroclinical Seizures
      • Phenobarbital 20 mg/kg
        • 10 mg/kg boluses until 40-50 microgm/ml
      • Phenytoin 20 mg/kg
      • Lorazepam 0.1 mg/kg
      • Pyridoxine 50-100 mg IV with EEG
    • 16. Outcome
      • 45 % controlled after either phenobarb or phosphenytoin
      • 60 % controlled with both
      • 30% of survivors develop epilepsy
      • WORSE: HIE, meningitis, dysplasia
      • WORSE: electrographic seizures
      • BETTER : hypoCa, BINC, BIFC, stroke

    ×