1

1. Define seizures and differentiate

between epileptic and non-epileptic
seizures.
2. Know the incidence of neonatal
seizures.
3. Describe the four types of seizures
and their clinical pictures.
4. Identify benign movements that are
not seizures.

2
5. List the causes of neonatal
seizures, both common and less
common etiologies.
6. Diagnose neonatal seizures.
7. Treat neonatal seizures.
8. Inform parents of the neonate’s
prognosis.

3
Seizures are transient disturbances
in brain function manifesting as
episodic impairments in
consciousness in association with
abnormal motor or automatic
activity.

4
 Epileptic seizures originate from the
cortical neurons and are associated
with EEG changes.
 Non-epileptic seizures are initiated in
the subcortical area and are not
usually associated with any EEG
changes.
- provoked by stimuli and meliorated
by restraint and body repositioning.

5
 The overall incidence is 0.5% of all
term and preterm neonates.

 The incidence is higher in preterm

neonates (3.9% if gestational age
< 30 weeks).

6
Four types of seizures are
frequently encountered in
neonates:
Tonic Seizures
Clonic Seizures
Myoclonic Seizures
Subtle (Fragmentary) Seizures

7
 Tonic seizures can be either generalized or
focal.

 Generalized tonic seizures:

- Mainly manifest in preterm neonates (< 2500
grams).
- Tonic flexion or extension of the upper
extremities, neck, or trunk and are associated
with tonic extension of the lower extremities.
- In 85% of cases are not associated with any
autonomic changes such as increases in heart
rate or blood pressure, or skin flushing.

8
 Present with asymmetrical posturing
of one of the limbs or trunk or with
tonic head or eye deviation.

 Mostly occur with diffuse central

nervous system disease and
intraventricular hemorrhage.

9
 Consist of slow (1-3 /minute) rhythmic
jerking movements of the extremities.
They may be focal or multi-focal. Each
movement is composed of a rapid
phase followed by a slow one.
 Changing the position or holding the
moving limb does not suppress the
movements. They are commonly seen
in full-term neonates >2500 grams

10
 There is no loss of consciousness and
they are associated with focal
trauma, infarction or metabolic
disturbances.

11
 Myoclonic seizures can be focal,
multi focal or generalized.
 Focal myoclonic seizures typically
involve the flexor muscles of the
extremities.
 Multi-focal myoclonic seizures
present as asynchronous
twitching of several parts of the
body.

12
 Generalized myoclonic seizures
present as massive flexion of the
head and trunk with extension or
flexion of the extremities. They are
associated with diffuse CNS
pathology.

13
Usually occurs in association with
other types of seizures and may
manifest with:
 Stereotypic movements of the
extremities such as bicycling or
swimming movements.
 Deviation or jerking of the eyes with
repetitive blinking.
14
 Drooling, sucking or chewing
movements.
 Apnea or sudden changes in
respiratory patterns.
 Rhythmic fluctuations in vital signs.

15
 Jitteriness
Sleep apnea
Isolated sucking movements
Benign neonatal sleep
myoclonus

16
Jitteriness is often misdiagnosed
as clonic seizures. Clinically they
differ from clonic seizures in the
following aspects:

17
 The flexion and extension phases are
equal in amplitude.
 Neonates are generally alert, with no
abnormal gaze or eye movements.
 Passive flexion or repositioning of the
limb diminishes the tremors. Tremors
are provoked by tactile stimulation,
though they may be spontaneous.
 No EEG abnormalities.

18
 often seen in neonates with
hypoglycemia, drug withdrawal,
hypocalcemia, hypothermia and in
(SGA) neonates.
 spontaneously resolve within few
weeks.

19
Not associated with abnormal
movements and is usually
associated with bradycardia.

When seizures are present with

apnea abnormal movements,
tachycardia and increased blood
pressure are present as well.

20
Random, infrequent and not well
sustained sucking movements are
not seizures.

21
 Predominantly seen in preterm
neonates during sleep. They can
be focal, multi-focal, or
generalized. They do not stop with
restraint.
 Resolve spontaneously within a
few minutes and require no
medication.
22
They differ from myoclonic seizures in
the following:

can be triggered by noise or motion.

 suppressed by the waking state.
not associated with any autonomic
changes.

23
 HIE
 Infections (TORCH, meningitis,
septicemia)
 Hypoglycemia, hypocalcemia,
hypomagnesemia
 CNS bleed (intraventricular,
subdural, trauma, etc.)

24
  Congenital brain anomalies
 Inborn errors of metabolism
 Maternal drug withdrawal (heroin,
barbiturates, methadone, cocaine, etc.)
 Kernicterus
 Pyridoxine (B6) dependency, and
hyponatremia

more than one underlying cause

25
Obtain a good maternal and
obstetric history

26
Primary tests
 Blood glucose
 Blood calcium and magnesium
 Complete blood count, differential
leukocytic count and platelet count
 Electrolytes
 Arterial blood gas
 Cerebral spinal fluid analysis and cultures
 Blood cultures

27
 TORCH titers, ammonia level, head
sonogram and amino acids in urine.
 EEG
Normal in about 1/3 of cases
 Cranial ultrasound
For hemorrhage and scarring
 CT
To diagnose cerebral malformations
and
hemorrhage

28
 Management goals
 Achieve systemic homeostasis
(airway, breathing and
circulation).
 Correct the underlying cause if
possible.

29
 10% dextrose solution (2cc/kg IV)
empirically to any seizing neonate.
 Calcium gluconate (200mg/kg IV), if
hypocalcemia is suspected .
 Magnesuim sulfate 50%, 0.2ml/kg or 2ml
Eq/kg.
 Antibiotics in suspected sepsis.
 In pyridoxine dependency give pyridoxine
50mg IV as a therapeutic trial. Seizures
will stop within minutes .

30
31
32
33
 Best prognosis  Hypocalcemia
with:  Pyridoxine dependency
 Subarachnoid
hemorrhage

 Worse prognosis
with:  Hypoglycemia
 Anoxia
 Brain malformation
 Sequelae:
 Chronic seizures 15-
20%
 Mental retardation
 Cerebral palsy 34
TERIMAKASIH

35