Abstract
Neonatal seizures are the most important indicators of underlying brain injury. Seizures in a neonate are different from seizures in older children in many aspects including clinical presentation and etiology. The neonatal brain is immature and tends to have a decreased seizure threshold. Neonatal seizures are classified, based on their presentation as, clinical seizures, electroclinical seizures and electroencephalographic seizures; based on the pathophysiology as epileptic and nonepileptic seizures; and also on the basis of the etiology. Hypoxic ischemic encephalopathy is the leading cause of neonatal seizures, followed by intracranial hemorrhage, metabolic causes such as hypoglycemia and hypocalcemia, intracranial infections and strokes. Neonatal epilepsy syndromes are rare. Electroencephalography (EEG) is the gold standard for diagnosis. Amplitude integrated EEG (aEEG) is also used for continuous monitoring. The approach to management consists of initial stabilization of the neonate followed by treatment of potentially correctable injurious processes such as hypocalcemia, hypoglycemia and electrolyte disturbances, etiology specific therapies and antiepileptic drug (AED) therapy. Phenobarbital remains the first line AED therapy. Pharmacokinetic data on newer drugs is limited. Prognosis depends on the etiology, seizure type, neurological examination at discharge and EEG. Long term neurodevelopmental follow up is essential for babies with neonatal seizures.
Similar content being viewed by others
References
Lanska MJ, Lanska DJ, Bauman RJ, Kryscio RJ. A population –based study of neonatal seizures in Fayette Country, Kentucky. Neurology. 1995;45:724–32.
Holdon KR, Mellits ED, Freeman JM. Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics. 1982;70:165–76.
Miller SP, Weiss J, Barnwell A, Ferriero DM, Latal-Hajnal B, Ferrer-Rogers A, et al. Seizure associated brain injury in term newborns with perinatal asphyxia. Neurology. 2002;58:542–8.
Pisani F, Sisti L, Seri S. A scoring system for early prognostic assessment after neonatal seizures. Pediatrics. 2009;124:e580–7.
Davis AS, Hintz SR, Van Meurs KP, Li L, Das A, Stoll BJ, et al. Seizures in extremely low birth weight infants are associated with adverse outcome. J Pediatr. 2010;157:720–5.
Garkinfle J, Shevell MI. Cerebral palsy, development delay, and epilepsy after neonatal seizures. Pediatr Neurol. 2011;44:88–96.
Ronen GM, Penney S, Andrews W. The epidemiology of clinical neonatal seizures in newfoundland: a population based study. J Pediatr. 1999;134:71–5.
Saliba RM, Annegers JF, Waller DK, Tysori JE, Mizrahi EM. Incidence of neonatal seizure in Harris Country, Texas, 1992–1994. Am J Epidemiol. 1999;150:763–9.
Glass HC, Pham TN, Danielsen B, Towner D, Glidden D, Wu YW. Antenatal and intrapartum risk factors for seizure in term new borns: a population-based study, California 1998–2002. J Pediatr. 2009;154:24–8e1.
Scher MS, Hamid MY, Steppe DA, Beggarly ME, Painter MJ. Ictal and interictal electrographic seizure durations in preterm and term neonates. Epilepsia. 1993;34:284–8.
Volpe JJ. Neurology of the newborn. 2nd ed. Philadelphia: Elsevier; 1987.
Shellhaas RA, Clancy RR. Characterization of neonatal seizures by conventional EEG and single-channel EEG. Clin Neurophysiol. 2007;118:2156–61.
Abend NS, Courtney JW. Neonatal seizures and status epilepticus. J Clin Neurophysiol. 2012;29:441–8.
Ben Ari Y, Holmes GI. Effects of seizures on developmental processes in the immature brain. Lancet Neurol. 2006;5:1055–63.
Jensen FE. Neonatal seizures: an update on mechanisms and management. Clin Perinatol. 2009;36:881–900.
Rakhade SN, Jensen FE. Epileptogenesis in the immature brain: emerging mechanisms. Nat Rev Neurol. 2009;5:380–91.
Mizrahi EM, Kellawaay P. Characterization and classification of neonatal seizure. Neurology. 1987;37:1837–44.
Volpe JJ. Neurology of the newborn. 5th ed. Philadelphia: Elsevier; 2008.
ILAE. Proposal for revised classification of epilepsies and epileptic syndromes. Commission on classification and terminology of the international league against epilepsy. Epilepsia. 1989;30:389–99.
Bergam I, Painter MJ, Crumrine PK. Neonatal seizures. Semin Perinatol. 1982;6:54–67.
Levene MI, Trounce JQ. Cause of neonatal convulsions. Towards more precise diagnosis. Arch Dis Child. 1986;61:78–9.
Mizrahi EM, Kellaway P. Diagnosis and management of neonatal seizures. 1st ed. Philadelphia: Lippincott-Raven; 1998.
Estan J, Hope P. Unilateral neonatal cerebral infraction in full – term infants. Arch Dis Child Fetal Neonatal Ed. 1997;76:F88–93.
Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J, et al. The current etiologic profile and neurodevelopmental outcome of seizure in term newborn infants. Pediatrics. 2006;117:1270–80.
Scharer G, Brocker C, Vasiliou V, Creadon-Swindell G, Gallagher RC, Spector E, et al. The genotypic and phenotypic spectrum of pyridoxine-dependent epilepsy due to mutations in ALDH7A1. J Inherit Metab Dis. 2010;33:571–81.
Baxter P. Epidemiology of pyridoxine dependent and pyridoxine responsive seizures in the UK. Arch Dis Child. 1999;81:431–3.
Gallagher RC, Van Hove JLK, Scharer G, Hyland K, Plecko B, Waters PJ, et al. Folinic acid-responsive seizures are identical to pyridoxine-dependent epilepsy. Ann Neurol. 2009;65:550–6.
Berg A, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE commission on classification and terminology, 2005–2009. Epilepsia. 2010;51:676–85.
Tharp BR. Neonatal seizures and syndromes. Epilepsia. 2002;43:S2–10.
Aicardi J, Ohtahara S. Severe neonatal epilepsies with burst suppression pattern. In: Roger J, Bureau M, Dravet C, Dreifuss A, Perrot A, Wolf P, editors. Epileptic syndromes in infancy, childhood and adolescence. 4th ed. London: John Libbey; 2005. p. 39–50.
Rose AL, Lombroso CT. A study of clinical, pathological, and electroencephalographic features in 137 full term babies with a long – term follow-up. Pediatrics. 1970;45:404–25.
De Vries LS, Hellstrom-Westas L. Role of cerebral function monitoring on the newborn. Arch Dis Child Fetal Neonatal Ed. 2005;90:F201–7.
De Vries LS, Toet MC. Amplitude integrated electroencephalography in the full-term newborn. Clin Perinatol. 2006;33:619–32.
Shellhaas RA, Soaita AI, Clancy RR. Sensitivity of amplitude-integrated electroencephalography for neonatal seizure detection. Pediatrics. 2007;120:770–7.
Booth D, Evans DJ. Anticonvulsants for neonates with seizures. Cochrane Database Syst Rev. 2004;18:CD004218.
Filippi L, la Marca G, Cavallaro G, Fiorini P, Favelli F, Malvagia S, et al. Phenobarbital for neonatal seizures in hypoxic-ischemic encephalopathy: a pharmacokinetic study during whole body hypothermia. Epilepsia. 2011;52:795–801.
Abend NS, Gutierrez-Colina AM, Monk HM, Dlugos DJ, Clancy RR. Levetiracetam in the treatment of neonatal seizures. J Child Neurol. 2011;26:465–70.
Khan O, Chang E, Ciprian C, Wright C, Crisp E, Kirmani B. Use of intravenous levetiracetam for management of acute seizures in neonates. Pediatr Neurol. 2011;44:265–9.
Siverstein FS, Ferriero DM. Off-label use of antiepileptic drugs for the treatment of neonatal seizures. Pediatr Neurol. 2008;39:77–9.
McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neurodevelopmental outcome. Neurology. 2000;55:506–13.
Ronen GM, Buckley D, Penney S, Streiner DL. Long term prognosis in children with neonatal seizures: a population-based study. Neurology. 2007;69:1816–22.
Garcias Da Silva LF, Nunes ML, da Costa JC. Risk factors for developing epilepsy after neonatal seizures. Pediatr Neurol. 2004;30:271–7.
Iype M, Prasad M, Nair PMC, Geetha S, Kailas L. The newborn with seizures- a follow up study. Indian Pediatr. 2008;45:749–52.
Conflict of Interest
None.
Source of Funding
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kanhere, S. Recent Advances in Neonatal Seizures. Indian J Pediatr 81, 917–925 (2014). https://doi.org/10.1007/s12098-014-1540-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-014-1540-2