Neonatal convulsion

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Neonatal convulsion

  1. 1. NEONATAL CONVULSIONSSANJAY RAO(090101361)
  2. 2. INTRODUCTION A seizure is a paroxysmal manifestation ofneurological dysfunctionIncidence(overall):2 in 1000 to 14 in 1000 live births
  3. 3. PATHOPHYSIOLOGY Excessive depolarisation (excitation) ofneurons within the CNS.
  4. 4. Probable Mechanisms of SomeNeonatal SeizuresFailure of sodium potassium pump mechanismleading to depolarisation due to inward migrationof sodium and repolarisation due to efflux ofpotassiumRelative excess of excitatory neurotransmittersDeficit of inhibitory neurotransmitters
  5. 5. variable clinical manifestations.often the first sign of neurologic dysfunctionpredictors of long-term cognitive anddevelopmental impairment.
  6. 6. TYPES OF NEONATAL SEIZURES5 main seizure typesSubtleTonicClonicMyoclonicSpasms
  7. 7. SUBTLE SEIZURES Transient eye deviations (term) Nystagmus , fixed stare (preterm) Abnormal extremity movements ( rowing,pedaling , swimming) Apnea , fluctuations in heart rate
  8. 8. TONIC SEIZURES May be focal or generalized Focal seizures –persistent posturing of a limb ortrunk with persistent horizontal eye deviation generalized seizures-bilateral tonic limbextension or tonic flexion of upper extremities withtonic extension of lower extremities
  9. 9. CLONIC SEIZURES Repetitive , rhythmic contractions of musclegroups of the limbs , face or trunk Consciousness may be preserved Signals focal cerebral injury
  10. 10. MYOCLONIC SEIZURES rare random , single , rapid contractions of musclegroups of the limbs , face or trunkTypically not repetitive or may recur at a slowrate
  11. 11. SPASMSSudden generalized jerks lasting 1-2 sec and areusually associated with a single , very brief,generalized discharge
  12. 12. D/DsJitterinessmust be differentiated from seizures inneonates. rapid motor activities such as a tremor or shake jitteriness is not associated with oculardeviation.-is stimulus sensitive (eg, easily stopped withpassive movement of the limb)
  13. 13. ETIOLOGYHypoxic-ischemic encephalopathyIntracranial Hemorrhagesubarachnoid hemorrhagegerminal matrix –intraventricular hemorrhagesubdural hemorrhageMetabolic disorders(hypoglycemia/hypocalcemia /hypomagnesemia/hyponatremia)
  14. 14. CONTD..Intracranial infectionsbacterial meningitisTORCH infections Pyridoxine dependencyBenign neonatal seizures
  15. 15. DIAGNOSISHISTORY:Family history may suggest genetic syndromeMany of these syndromes are benign In the absence of other etiologies, family historyof seizures may suggest good prognosis
  16. 16. Antenatal history is importantHistory of fetal distress, preeclampsia , maternalinfections or maternal diabetes
  17. 17. Delivery historyType of delivery and antecedent eventsApgar scores offer some guidanceLow Apgar score without the need forresuscitation and subsequent neonatal intensivecare is unlikely to be associated with neonatalseizures
  18. 18. INVESTIGATIONS: Lab studies-Blood count-Blood, urine & CSF culture-Serum IgM & IgG-specific TORCH titres-Blood biochem.->evaluation of Glu, Ca, Mg,electrolytes-Blood gas levels to detect acidosis & hypoxia.
  19. 19. EEG:Main tool for diagnosisIt is useful to confirm a clinically doubtfulconvulsion , to locate an epileptic focus andand to determine its anatomical basis Ultrasonography and CT scan of head:To detect subarachnoid /intraventricularhemorrhage
  20. 20. TREATMENTThe principles of Rx are:To control convulsionsTo treat the underlying pathology
  21. 21. To control convulsion:I.V. phenobarbitone 20 mg/kg body weight overa period of 10-15 minMaintenance dose-> 2.5 to 4 mg/kg b.w. per daygiven orally or I.M. for a pd. of 2 wks or longer.In resistant cases-> I.V. phenytoin 20 mg/kgb.w @ 1 mg/kg/min
  22. 22. Maintenance dose of 5-8 mg/kg/day divided 12hourly.Fosphenytoin is preferred.
  23. 23. To treat the underlying pathologyHypoglycemia : Glucose infusion 2 ml per kg of10% glucose, through an I.V. line is given over 2-3 minHypomagnesemia: MgSO4(0.4-0.8 mEq/kg);given IV every 12 hours until Mg level is normal.Infection: Appropriate antibiotics
  24. 24. Hypocalcemia: I.V administration of 2 ml/kg ofCalcium gluconate given over 5 min.- To be followed by oral Calcium Chloride250 mg with each feed for few days.Pyridoxine deficiency: IV administration of 50mg pyridoxine is effective.
  25. 25. PROGNOSIS:Varies with etiology.Hypocalcemic convulsions have an excellentprognosis.Neurological sequelae are still around 30-40%
  26. 26. References:Nelson textbook of pediatrics (19thedition) Averys diseases of newborn(8thedition)D.C.Dutta textbook of obstetrics(7thedition)

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