Neonatal Seizures

  • 2,149 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
2,149
On Slideshare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
198
Comments
0
Likes
1

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