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

3,329
views

Published on

Published in: Health & Medicine

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

No Downloads
Views
Total Views
3,329
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
341
Comments
0
Likes
6
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 Dr. Kalpana Malla MD Pediatrics Manipal Teaching HospitalDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
  • 2. INTRODUCTION• Not uncommon•Always due to some underlying cause•25% cases cause – unknown•Often first sign of neurological disorders•Powerful predictors of long termcognitive and developmental impairement
  • 3. Pathophysiology1.Large group of neurons undergo excessive, synchronized depolarization which results from –a) Increase in excitatory neurotransmitters (glutamate)b) Decrease in inhibitory neurotransmitters (gamma amino butyric acid- GABA
  • 4. PROBABLE MECHANISMSc. Disruption of ATP – dependent resting membrane potentials - Failure of Na - K pump – flow of sodium into the neuron & potassium out of neurond. Membrane alteration - Increased Na permeability
  • 5. Incidence• 1 in 200 healthy newborns• 0.5 -0.8% Term babies• 6-12% <1.5 kg (1 in 4 premature and LBW• Many seizures are very subtle – go undetected
  • 6. SEIZURE PATTERN1. Subtle seizure: 50%of seizures- Tonic horizontal deviation of eyes, staring look,Repetitive blinking / fluttering of eyelids - Oro- buccal movements-chewing, lip smacking, sucking, yawning - Tonic posturing of a limb - Apnea- Swimming/ bycycling movements
  • 7. SEIZURE PATTERN2.Clonic - Focal / Multifocal – twitching migrate haphazardly from one limb to another, occur due to HIE & birth trauma3.Generalised seizure - rare
  • 8. SEIZURE PATTERN4. Focal clonic – Localized & often assoc with loss of consciousness They are signs of bilateral c’bral disorder Common in metabolic disorder, birth trauma and c’bral infarction
  • 9. SEIZURE PATTERN5. Tonic seizure – - Stiffening similar to decerebrate posture but with eye signs and heavy breathing - Often associated with apnea - Seen in IVH, preterm and Kernicterus
  • 10. SEIZURE PATTERN6.Myoclonic seizures• Rare in newborns• Single/multiple flexion movements, slow and jerky• Seen in developmental defects and anencephaly
  • 11. Features Jitteriness SeizureStimulus ++ _ sensitiveCessation Passive flexion - Gentle graspRhythmicity Rhythmic Fast & slow oscillation components
  • 12. Features Jitterine Seizure ssFrequency of jerks 5-6 / sec 2-3 / secAbnormal gaze-Eye Nil PresentmovementAutonomic disturbance Nil Increase HR, BP)EEG Normal Abnormal
  • 13. ETIOLOGYA. Perinatal causes 1. Neonatal encephalopathy - 20- 40% of seizures2. Intracranial hemorrhages- CNS trauma, SAH, PVH,
  • 14. B. METABOLIC CAUSES• Hypoglycemia• Hypocalcemia – most common metabolic cause for NNS• Hypomagnesemia• Hypo / Hypernatremia• Pyridoxine dependency• IEM - Disorders of amino acid metabolism
  • 15. C. Infections• Intracranial - Meningitis - encephalitis – herpes, coxachie, echo, CMV, - ToxoplasmosisExtracranial – septicemia - Tetanus - Severe rep distress
  • 16. D. Developmental defects– Cerebral Dysgenesis– Hydrocephalus– Microcephaly– Neuronal migration defects- Lissencephaly,pachygyria,schizenceph aly
  • 17. OthersE. Drugs- prolonged maternal administration - Vit B6-pyridoxin dependancy - Narcotic withdrawal - TheophyllineF. PolycythemiaG. Focal infarcts
  • 18. OthersH .Hypertensive encephalopathyI . Benign familial epilepsy – does not continue after neonatal periodJ .Unknown(Idiopathic : 3-25%
  • 19. Diagnosis – time of onset• 1st day – birth asphyxia (HIE) - C’bral trauma - Pyridoxin dependancy - Narcotic withdrawal - IEM
  • 20. Diagnosis – time of onset• 1-3 days – - ICH - Hhypocalcemia - Hypoglycemia - Hypo & hypernatremia - Pyridoxin deficiency - Cong C’bral malformations - Narcotic withdrawal
  • 21. Diagnosis – time of onset• 4-7 days – - Meningitis - Encephalitis - Hypomagnesemia - TORCH infection - Developmental malformations - Kernicterus - IEM - Pyridoxin dependancy - Tetanus
  • 22. Refractory seizures• IEM –• Developmental defects of CNS• Narcotic withdrawal• Pyridoxin dependancy• Kernicterus• Benign familial seizures
  • 23. Investigations• CBC• Blood – glucose, calcium, electrolytes, Mg, bilirubin, ABG• CSF analysis• Blood C/S , urine C/S• Cranial USG
  • 24. Second line investigations• TORCH screening• IEM screening – urine organic acids• - S. amino acid assay• Imaging – CT scan - MRI - EEG brain
  • 25. Management• Collect all samples• IV line• Thermoneutral environment• Glucose 10% - 2-4ml/kg as bolus followed by 10% glucose as drip @ 8mg/kg/min• IV calcium – gluconate 2ml/kg
  • 26. ANTICONVULSANTSPhenobarbitone 15 - 20mg / kg IV loading dose 3.5 - 5mg / kg / day maintenance dosePhenytoin 15 - 20 mg / kg IV at 1mg / kg / min 4 - 8 mg / kg day maintenance doseMidazolam 0.02 - 0.4 mg/kg IM 0.02 - 0.1mg/kg IV 0.06 - 0.4mg/kg/hrOthers Lorazepam, diazepam, Paraldehyde
  • 27. ANTICONVULSANTS• Phenobarbitone ↓↓• Phenytoin ↓↓• Lorazepam, midazolam drip – 48 hrs ↓↓
  • 28. ANTICONVULSANTS ↓↓• Barbiturate coma – pentobarbital& thiopental on ventilator – try to wean every 24 hrs ↓↓• GA with isoflurane or halothane + neuromuscular blockade (muscle paralysis)
  • 29. TREATMENT1. Optimise ventilation Maintain CO, BP, Serum electrolytes & pH2. Treat underlying diseases- Metabolic abnormalities,meningitis,Narcotic withdrawal3. Pyridoxine dependency- 50mg IV, repeatevery 10 min till control- maintenance dose –5mg/kg PO daily6. Hyperbilirubinemia –phototherapy, exchange transfusion
  • 30. Benign familial neonatal seizure• Typically occur in first 48- 72 hrs of life• Disappear by age 2-6 months• A family history seizures is usual• Development - normal
  • 31. Benign idiopathic NNS• Typically Presents at day 5 of life• Also called 5th day fits• Multifocal in type• No cause detected
  • 32. FOLLOW UP - ANTICONVULSANTS1. Stop all others except maintenance PB2. Maintenance PB : 2wks - 2months3. Risk of recurrence Little: transient metabolic abnormalities 30-50% : HIE High : Cortex malformations
  • 33. PROGNOSISNormal Outcome: 56%Neurological sequelae: 30 - 40%Death : 15-25%Chronic seizure disorder: 15-20%Outcome depends on 1. Level of maturity 2. Etiology 3. Neurological examination 4. EEG / Imaging studies
  • 34. GOOD PROGNOSIS• Uncomplicated hypoglycemia• Narcotic withdrawal• SAH
  • 35. POOR PROGNOSIS• Low APGAR score ≤ 6 at 5min• Onset o seizures within 24 hrs of life• Presence of myoclonic attacks• Abnormal EEG• 3 or more days of uncontrolled seizures
  • 36. Thank youDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]

×