Neonatal seizures

Introduction
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By Elissa G Yozawitz MD, Emma Laureta MD, and Solomon Moshé MD

Neonatal seizures are seizures occurring within the first 28 days in a full-term infant and extending to the 44 completed weeks gestational age in the preterm infant. The neonatal period is the most vulnerable of all periods of life for development of epileptic seizures. Most neonatal seizures are acute reactive (structural/metabolic) seizures, the most common cause being hypoxic-ischemic encephalopathy, stroke, or infection. Neonatal seizures appear most often early after birth, usually during the first 1 to 2 days of life. Neonatal seizures may be associated with neurodevelopmental delay or death, with possible long-term motor and cognitive problems. Elissa Yozawitz MD, Emma Laureta MD, and Solomon L Moshé MD of the Department of Neurology and Pediatrics at Albert Einstein College of Medicine in Bronx, New York, present this information as well as the pathophysiology, localization, diagnostic workup, differential diagnosis, and updates in the management of neonatal seizures.

Key Points

  • The neonatal brain is more prone to seizures than the mature brain.
  • Most neonatal seizures are acute reactive seizures, the most common cause being hypoxic-ischemic encephalopathy, stroke, or infection.
  • The most commonly used classification of neonatal seizures divides the seizures into clonic, tonic, myoclonic, and motor automatisms/subtle.
  • About 60% to 70% of neonatal seizures are subclinical and would not be recognized without continuous EEG monitoring.
  • Phenobarbital is a first-line treatment for neonatal seizures. Fosphenytoin/phenytoin can also be used or added for additional benefit, as well as midazolam. Additional medications that may be used as an off-label medication include levetiracetam or topiramate. There is a need for new treatments that are age specific.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Localization
Pathophysiology
Differential diagnosis
Diagnostic workup
Syndromes and diseases in which the seizure type occur
Prognosis and complications
Management
References cited
Contributors