NEONATAL SEIZURES

1. NEONATAL SEIZURES
DIANA PRASAD
MSc NURSING (Pediatrics)
WESTFORT COLLEGE OF NURSING

2.  A stereotypic, paroxysmal spell of
altered neurologic function
(behavior, motor,and/or autonomic
function)
DEFINITION

3.  Neonatal period limited to :
- first 28 days for term infants
- 44 weeks gestational age for
pre-term

4.  Immature CNS cannot sustain a synchronized, well
orchestrated generalized seizure
Why do neonatal seizures have such
unusual presentations?

5. A. Perinatal causes
1. Neonatal encephalopathy - 20-
40% of seizures
2. Intracranial hemorrhages- CNS
trauma, SAH, PVH,
ETIOLOGY

6.  Hypoglycemia
 Hypocalcemia – most common metabolic cause
for NNS
 Hypomagnesemia
 Hypo / Hypernatremia
 Pyridoxine dependency
 IEM - Disorders of amino acid metabolism
B. METABOLIC CAUSES

7.  Intracranial
- Meningitis
- encephalitis – herpes, coxachie, echo, CMV,
- Toxoplasmosis
Extracranial
– septicemia
- Tetanus
- Severe rep distress
C. Infections

8.  Cerebral Dysgenesis
 Hydrocephalus
 Microcephaly
 Neuronal migration defects-
Lissencephaly,pachygyria,schizenc
ephaly
D. Developmental defects

9. H .Hypertensive encephalopathy
I . Benign familial epilepsy – does not
continue after neonatal period
J .Unknown(Idiopathic : 3-25%
Others

10. Probable Mechanisms of Some Neonatal Seizures
PROBABLE MECHANISM DISORDER
Failure of Na + -K + pump secondary to Hypoxemia, ischemia,
 adenosine triphosphate and hypoglycemia
Excess of excitatory neurotransmitter
(eg.glutamic acid—excessive excitation) Hypoxemia, ischemia
and hypoglycemia
Deficit of inhibitory neurotransmitter Pyridoxine dependency
(i.e., relative excess of excitatory
neurotransmitter)
Membrane alteration—  Na + Hypocalcemia and
Permeability hypomagnesemia

11. I. Clinical Seizure
 Subtle
 Tonic
 Clonic
 Myoclonic
Classification

12. 1. Subtle
 More in preterm than in term
 Eye deviation (term)
 Blinking, fixed stare (preterm)
 Repetitive mouth and tongue movements
 Apnea
 Pedaling and tonic posturing of limbs
Clinical Classification

13. 2. Tonic
 Primarily in Preterm
 May be focal or generalized
 Sustained extension of the upper and
lower limbs (mimics decerebrate posturing)
 Sustained flexion of upper with extension of
lower limbs (mimics decorticate posturing)
 Signals severe ICH in preterm infants
Clinical Classification

14. 3. Clonic
 Primarily in term
 Focal or multifocal
 Clonic limb movements(synchronous or
asynchronous, localized or often with no anatomic
order of progression)
 Consciousness may be preserved
 Signals focal cerebral injury
Clinical Classification

15. 4. Myoclonic
 Rare
 Focal, multifocal or generalized
 Lightning-like jerks of extremities
(upper > lower)
Clinical Classification

16.  Certain clinical seizures in the human
newborn originate from electrical seizures
in deep cerebral structures (limbic regions),
or in diencephalic, or brain stem structures
and thereby are either not detected by
surface-recorded EEG or inconsistently
propagated to the surface
Does absence of EEG seizure activity indicate
that a clinical seizure is non- epileptic?

17. (1) electroencephalogram
(2) blood glucose
(3) serum calcium
(4) serum magnesium
(5) arterial pH
(6) serum sodium
(7) serum urea and creatinine
(8) lumbar puncture
(9) blood culture
(10) cranial ultrasound scan
DIAGNOSIS

18.  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
Management

19. ANTICONVULSANTS
Phenobarbitone
15 - 20mg / kg IV loading dose
3.5 - 5mg / kg / day maintenance dose
Phenytoin
15 - 20 mg / kg IV at 1mg / kg / min
4 - 8 mg / kg day maintenance dose
Midazolam 0.02 - 0.4 mg/kg IM
0.02 - 0.1mg/kg IV
0.06 - 0.4mg/kg/hr
Others Lorazepam, diazepam, Paraldehyde

20.  Phenobarbitone
↓↓
 Phenytoin
↓↓
 Lorazepam, midazolam drip – 48 hrs
ANTICONVULSANTS

21. TREATMENT
1. Optimise ventilation
Maintain CO, BP, Serum electrolytes & pH
2. Treat underlying diseases- Metabolic abnor
malities,meningitis,Narcotic withdrawal
3. Pyridoxine dependency- 50mg IV, repeat every 10 min till control-
maintenance dose – 5mg/kg PO daily
6. Hyperbilirubinemia –phototherapy,
exchange transfusion

22. FOLLOW UP -
ANTICONVULSANTS
1. Stop all others except maintenance PB
2. Maintenance PB : 2wks - 2months
3. Risk of recurrence
Little: transient metabolic abnormalities
30-50% : HIE
High : Cortex malformations

23. PROGNOSIS
Normal 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

24. Uncomplicated hypoglycemia
Narcotic withdrawal
SAH
GOOD PROGNOSIS

25.  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
POOR PROGNOSIS

26. THANK YOU