Presentation with extensive details of neonatal seizure. Covering its etiology, diagnosis and treatment . Neonatal seizure is one of the commonest clinical situation faced by any one working in a neonatal unit. Furthermore it is a favourite topic of many examiners in MD/DCH/DNB Pediatrics exams.
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
Definition
A seizure is defined clinically as a paroxysmal alteration in neurologic function (i.e., behavioral, motor, or autonomic function).
Includes phenomena that are associated temporally with seizure activity identifiable on an EEG and, therefore, are clearly epileptic
Also includes paroxysmal clinical phenomena that are not consistently associated temporally with EEG seizure activity
Pathophysiology
Immature brain has many differences from the mature brain that render it more excitable and more likely to develop seizures.
Delay in Na+ , K+ -adenosine triphosphatase maturation and increased NMDA and AMPA receptor density.
Delay in the development of inhibitory GABAergic transmission
GABA in the immature brain has an excitatory function
Causes of Neonatal seizures
The majority of neonatal seizures occur in the context of acute neurologic disorders.
Thus most neonatal seizures may be considered acute symptomatic seizures, which have been defined as seizures occurring at the time of a systemic insult or in close temporal association (often 1 week) with a documented brain insult.
The current IL AE classifies seizure causes as genetic, structural/metabolic, and unknown.
Within that classification scheme, the majority of neonatal seizures are structural/ metabolic in etiology.
The most common underlying etiologies are HIE, stroke, intracranial hemorrhage, intracranial infections, and cerebral dysgenesis.
Less common but important etiologies include
Inborn errors of metabolism and
Neonatal epileptic syndromes, such as benign familial neonatal epilepsy, benign nonfamilial neonatal seizures, early myoclonic epilepsy, early infantile epileptic encephalopathy, and malignant migrating partial seizures of infancy
Types of Neonatal Seizures
Four essential clinically evident seizure types can be recognized: subtle, clonic, tonic, and myoclonic
Subtle seizures do not have a clear position in the most recent ILAES classification report, but they are very common in newborns
A critical fifth seizure type to consider in newborns is a seizure with no observable clinical correlate, which have been referred to as EEG-only seizures
An important initial distinction in classifying a seizure is whether it has a generalized or focal mechanism of onset
Subtle Seizures
Transient eye deviations, nystagmus, blinking, mouthing,
Abnormal extremity movements (rowing, swimming, bicycling, pedalling, and Stepping),
Fluctuations in heart rate, hypertension episodes, and apnea.
More commonly in premature
Clonic Seizures
Focal:
Involve face upper + /- lower extremities on
one site “axial structures (neck / trunk)
Usually associated with neuropathology (i.e. Cerebral infarction and intra cerebral haemorrhage)
Multi focal:
Involve several body parts and often
migrate in a non-jacksonian (random) manner may also involve the face.
Consider the neonatal equivalent of generalized tonic – clonic seizures.
Contents
Definition of Seizure and Epilepsy
Epidemiology
Classification of seizure
Pathophysiology of seizures
Evaluation Patients Presenting with Seizure
Focal seizure and related epilepsy syndromes
Generalized seizures and Epilepsy syndromes
Treatment of seizures and Epilepsy
Presentation with extensive details of neonatal seizure. Covering its etiology, diagnosis and treatment . Neonatal seizure is one of the commonest clinical situation faced by any one working in a neonatal unit. Furthermore it is a favourite topic of many examiners in MD/DCH/DNB Pediatrics exams.
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
Definition
A seizure is defined clinically as a paroxysmal alteration in neurologic function (i.e., behavioral, motor, or autonomic function).
Includes phenomena that are associated temporally with seizure activity identifiable on an EEG and, therefore, are clearly epileptic
Also includes paroxysmal clinical phenomena that are not consistently associated temporally with EEG seizure activity
Pathophysiology
Immature brain has many differences from the mature brain that render it more excitable and more likely to develop seizures.
Delay in Na+ , K+ -adenosine triphosphatase maturation and increased NMDA and AMPA receptor density.
Delay in the development of inhibitory GABAergic transmission
GABA in the immature brain has an excitatory function
Causes of Neonatal seizures
The majority of neonatal seizures occur in the context of acute neurologic disorders.
Thus most neonatal seizures may be considered acute symptomatic seizures, which have been defined as seizures occurring at the time of a systemic insult or in close temporal association (often 1 week) with a documented brain insult.
The current IL AE classifies seizure causes as genetic, structural/metabolic, and unknown.
Within that classification scheme, the majority of neonatal seizures are structural/ metabolic in etiology.
The most common underlying etiologies are HIE, stroke, intracranial hemorrhage, intracranial infections, and cerebral dysgenesis.
Less common but important etiologies include
Inborn errors of metabolism and
Neonatal epileptic syndromes, such as benign familial neonatal epilepsy, benign nonfamilial neonatal seizures, early myoclonic epilepsy, early infantile epileptic encephalopathy, and malignant migrating partial seizures of infancy
Types of Neonatal Seizures
Four essential clinically evident seizure types can be recognized: subtle, clonic, tonic, and myoclonic
Subtle seizures do not have a clear position in the most recent ILAES classification report, but they are very common in newborns
A critical fifth seizure type to consider in newborns is a seizure with no observable clinical correlate, which have been referred to as EEG-only seizures
An important initial distinction in classifying a seizure is whether it has a generalized or focal mechanism of onset
Subtle Seizures
Transient eye deviations, nystagmus, blinking, mouthing,
Abnormal extremity movements (rowing, swimming, bicycling, pedalling, and Stepping),
Fluctuations in heart rate, hypertension episodes, and apnea.
More commonly in premature
Clonic Seizures
Focal:
Involve face upper + /- lower extremities on
one site “axial structures (neck / trunk)
Usually associated with neuropathology (i.e. Cerebral infarction and intra cerebral haemorrhage)
Multi focal:
Involve several body parts and often
migrate in a non-jacksonian (random) manner may also involve the face.
Consider the neonatal equivalent of generalized tonic – clonic seizures.
Contents
Definition of Seizure and Epilepsy
Epidemiology
Classification of seizure
Pathophysiology of seizures
Evaluation Patients Presenting with Seizure
Focal seizure and related epilepsy syndromes
Generalized seizures and Epilepsy syndromes
Treatment of seizures and Epilepsy
More than 10 million people suffer from epilepsy in India.Seizures impact the lives of people with epilepsy and their family in many ways including creating barriers to employment and education and facing a sense of discrimination and isolation from their peers who donʼt understand what happens when they see a seizure occur. In India, epilepsy is still thought of as mental illness mainly due to lack of information on the condition among the general public.
This presentation touches every aspect of epilepsy
1. Overview of Epilepsy;
2. Type of Seizures;
3. Diagnosis and Management;
4. Psychological Issues; and
5. Social Perspectives.
Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
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2. LEARNING OBJECTIVES
At the end of seminar student should be able to
1. Understand what is neonatal seizures
2. Know type of neonatal seizures and it
mimickers
3. List the causes and investigation
4. Understand the outcome and prognosis of
neonatal seizures
5. The current guideline management for
neonatal seizures
3. INTRODUCTION
• Seizure
– Is a paroxysmal behavior caused by
hypersynchronous discharge of a group of
neurons.
• The neonatal period is the most frequent time
to have seizures.
4. Cont.
• Seizures = most common manifestation of
neurological dysfunction in the newborn.
• The increased susceptibility to seizures may be
explained by
– Birth factors (e.g. Hypoxia ischemia, birth trauma)
– Developmental factors (excitatory effect of
gamma-amino butyric acid (GABA) in immature
brain).
5. Cont.
• Neonates may also exhibit paroxysmal non-
epileptic events than can mimic seizures
• It is important to differentiate
JITTERINESS
• Stimulus sensitive
• Aborts with gentle limb flexion
BENIGN NEONATAL SLEEP
MYOCLONUS
• Only occurs in sleep
• Aborts with arousal
STARTLE DISEASE
(HYPEREKPLEXIA)
• Excessive startle, stimulus
sensitive
• Jerks and generalized muscle
rigidity
8. CLINICAL SEIZURES EEG SEIZURES MANIFESTATION
SUBTLE Common Ocular phenomena
• Tonic horizontal deviation of eyes
common in term infants.
• Sustained eye opening with fixation
common in preterm infants.
• Blinking.
Oral-buccal-lingual movements
• Chewing common in preterm
infants.
• Lip smacking, cry-grimace.
Limb movements
• Pedaling, stepping, rotary arm
movements
Apnoeic spells
• Common in term infants
9. CLINICAL SEIZURES EEG SEIZURES MANIFESTATION
CLONIC
• Focal
• Multifocal
• Common
• Common
• Well localized clonic
jerking, infant usually
not unconscious
• Multifocal clonic
movements;
simultaneous, in
sequence or non-
ordered (non-
Jacksonian) migration
10. CLINICAL SEIZURES EEG SEIZURES MANIFESTATION
TONIC
• Focal
• Generalized
• Common
• Uncommon
Sustained posturing of a limb,
asymmetrical posturing of trunk or
neck
• Tonic extension of upper and
lower limbs (mimic decerebrate
posturing)
• Tonic flexion of upper limbs and
extension of lower limbs (mimic
decorticate posturing)
• Those with EEG correlates;
autonomic phenomena, e.g.
increased BP are prominent
features.
11. CLINICAL SEIZURES EEG SEIZURES MANIFESTATION
MYOCLONUS
• Focal, multifocal
• Generalized
• Uncommon
• Common
• Well localized, single or
multiple, migrating jerks
usually of limbs
• Single/several bilateral
synchronous jerks or
flexion movement more
in upper than lower
limbs.
12. Note:
• Subtle seizures
– Easily missed and requires correlation with EEG
• Focal clonic seizures
– May suggest a localized cerebral injury
– Eg. perinatal stroke
• Generalized tonic seizures
– are the commonest seizure type in preterm IVH
19. Thorough history, physical examination and
neurophysiological assessment with amplitude
integrated EEG (aEEG)/ continuous video
electroencephalography (cEEG) is often required in
newborns at risk for seizures.
Abnormal initial EEG background may predict higher
seizure risk in newborns with HIE.
It is very important to delineate whether the abnormal
movements/ paroxysmal events are seizures.
Where applicable correlation with aEEG is desirable as
this avoids unnecessary and potential side effects with
antiepileptic drugs (AED).
20. Controversies regarding extent of treatment
(i.e. whether to stop all clinical or
electrographic seizures) exist.
It is desirable to eliminate electroclinical and
electrographic graphic seizures especially if
they:
1) Are prolonged –more than 2-3 minutes.
2) Are frequent– more than 2-3 per hour.
3) Disrupt ventilation and/or blood pressure
homeostasis
21. IN ACUTE SETTING
Administer antiepileptic drugs intravenously to
achieve rapid onset of action and predictable
blood levels in order to achieve serum levels in
the normal therapeutic range.
MAINTENANCE THERAPY
Usually not required if loading doses of
anticonvulsant drugs are able to control
seizures.
22. A prolonged duration of AED maintenance (6-12
weeks) following acute neonatal seizures may be
considered in the following circumstances:
1) Higher probability of seizure recurrence
(stroke and hemorrhage)
2) Abnormal neonatal neurological examination
upon discharge
3) Abnormal EEG background upon discharge
Routine maintenance AED is not recommended
as some AEDs (phenobarbitone and phenytoin)
have neuro-apoptotic properties
23. In neonate with normal
neurological examination
and/or EEG findings
Consider stopping AED if
seizures free >72 hrs
The drug should be
reconstituted in case of
seizures recurrences
25. OUTCOME FOLLOWING NEONATAL
SEIZURES
• Depends primarily on the underlying cause.
• The presence of both
– Clinical (except focal clonic) and
– Electrographic seizures
• Often indicates brain injury and coupled with
– Abnormal EEG background
• Are important determinants for adverse
outcome
37. LEARNING OBJECTIVES
At the end of seminar student should be able to
1. Understand what is neonatal seizures
2. Know type of neonatal seizures and it
mimickers
3. List the causes and investigation
4. Understand the outcome and prognosis of
neonatal seizures
5. The current guideline management for
neonatal seizures
38. REFERENCES
• Paediatrics Protocol For Malaysian Hospital,
4th Edition, Kementerian Kesihatan Malaysia,
Chapter 21: Neonatal Seizures, Page: 127
• Nelson Textbook Of Pediatrics, 19th Edition,
Chapter 593.7 Neonatal Seizures Mohamad A.
Mikati And Abeer J. Hani, Page: 4096
