Neonatal Seizures.ppt

Neonatal Seizures Amy Kao, M.D. Division of Neurology Doernbecher Children’s Hospital Objectives Review the clinical presentation and differential diagnosis Discuss pathophysiologic implications on clinical presentation Review etiology Apply this information to evaluation and treatment Discuss prognosis Clinical Classification Focal/Multifocal Clonic Not generalized Migratory Not necessarily focal etiology Focal Tonic Not usually generalized Generalized Myoclonic Clinical Classification Subtle (“Hypomotor”) Motor activity arrest Apnea Eye deviation Autonomic changes Motor automatisms Oral-buccal-lingual movements Swimming Bicycling The Definition of a Seizure “paroxysmal discharge of cerebral neurons sufficient to cause clinically detectable events that are apparent either to the subject or to an observer” Definition of a Seizure in a Neonate? Excitatory activity predominates No paroxysmal discharge on EEG? True seizure The cortex is undeveloped Deeper origin “Brainstem release phenomena” Definition of a Seizure in a Neonate… Clinically detectable events? Subtle Truly only electrographic Iatrogenic paralysis High doses AEDs Encephalopathy or subcortical/spinal cord damage If It Isn’t a Seizure, Then What Is It?? Possible clues Stimulus-induced Suppressable No associated autonomic changes (usually not bradycardia) Weird Baby Movements Jitteriness Stimulus-sensitive “Tremor” Suppressable Benign neonatal sleep myoclonus Spinal myoclonus Apnea of non-neurologic etiology bradycardia Causes of Neonatal Seizures Within first 24 hours of life Hypoxic ischemic encephalopathy Meningitis/sepsis Subdural/Subarachnoid/Interventricular hemorrhage Intrauterine infection Trauma Pyridoxine dependency Drug effect/withdrawal Causes…. 24-72 hours Meningitis/sepsis In premature infants: IVH In full-term infants: infarction, venous thrombosis Cerebral dysgenesis Causes…. 72 hours to 1 week Above causes Inborn errors of metabolism Hypocalcemia Familial neonatal seizures 1 week to 4