Neonatal Seizure. Prepared by: Dr Ehab Bader Moderator: A. Al-Arini. Seizures are paroxysmal involuntary disturbance of brain function that maybe manifested as Impairment of Consciousness, abnormal motor activity, behavioral abnormality, sensory disturbance or autonomic dysfunction.
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Prepared by: Dr Ehab Bader
Moderator: A. Al-Arini
- Structural abnormality.
- Infectious Diseases.
-Incomplete arborization of axons, and dedritic processes as well as mylenation are also incomplete.
These seizures are characterized by random clonic movements of limbs similar to those seen in normal infants under 34 weeks of gestation. The EEG is most often unifocally abnormal, the prognosis is generally good.
3- Tonic seizures:
Divided into general and focal usually associated with eye deviation or apnea and most often seen in prematures and carry a poor prognosis.
the manifestations include synchronous single or multiple slow jerks of upper or lower limbs or both and are associated with diffuse CNS pathology, the prognosis is poor.
5- Subtle seizure:
50% of seizures in both term and prematures.
usually presented as:
Alteration of respiratory rate.
-Change in skin color.
-apnea due to seizures:
most often has either an:
accelerated or normal heart rate while apnea due to other cause usually associated with bradycardia.
1- Clinical seizures with a consistent EEG events. Which includes:
some myoclonic seizures.
These seizures are clearly epileptic and are likely to respond to an anticonvulsants
2- Clinical seizures with inconsistent EEG events:
seizures, subtle seizures and with some myoclonic seizures.
Seizures in this category are likely to be of non epileptic origin and may not require or respond to anti epileptics.
3- Electrical seizures with absent clinical seizures:
may develop in comatose infant who are not on anti convulsants, conversely electrical seizures may persist in patients with focal tonic or clonic seizures without clinical signs after the introduction of an anticonvulsant.
1-Hypoxic Ischemic Encephalopathy:
represent 60% - 65% of cases of neonatal seizures, occurs in babies with severe fetal distress who are apnic at birth. Seizures usually occur in the first day of life most often beginning in the first 12 hours.
-disorders of metabolism as phenylketoneurea, hyperglycinemia, urea cycle disorders and β-alanine abnormalities.
-biotin responsive disorders.
-fructose intolerance disorders.
5- Developmental disorders:
-fakomatosis which include: neurofibromatosis, sturge weber disease and tuberous sclerosis.
-narcotic and sedative withdrawal.
7- Polycythemia and hyperviscosity.
8- Familial neonatal seizures.
9- Focal infarction.
10- Hypertensive encephalopathy.
1- absence of abnormal gaze or eye movement.
2- provocation by stimulation of the infant or by stretching a joint in contrast to the usual spontaneous occurrence of seizures.
3- cessation of movements with passive fexion or gentle resistant .
4- absence of the fast and slow components that are characteristics of a clonic fit.
6- Repetitive jerks in seizures are at a rate of 2 to 3 per second, whereas clonus tend to be faster as 5-6 per second.
7- Jitterness and non-seizure clonus not accompanied by increased blood pressure, bradycardia, or tachycardia.
Prognosis of seizures by seizure pattern: Normal outcome(%) by gestational age at birth