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Epilepsies of neonatal onset: seizure type and evolution
K Watanabe1, K Miura, J Natsume
1Department of Pediatrics, Nagoya University School of Medicine, Japan. kwatana@med.nagoya-u.ac.jp
Insights
Most neonatal seizures are not true epilepsy. This study reveals that true neonatal epilepsies often present as partial seizures, with some evolving into West syndrome or other age-dependent epileptic syndromes.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Background:
- Neonatal seizures are common, but most are not indicative of true epilepsy.
- Understanding the specific seizure types and developmental trajectories of neonatal epilepsies is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the seizure types in true neonatal epilepsies.
- To examine the developmental evolution of these epileptic syndromes.
- To re-evaluate the classification of certain neonatal convulsion syndromes.
Main Methods:
- Retrospective study of 75 children with epilepsy onset within the first month of life.
- Confirmed seizure types using ictal electroencephalogram (EEG) recordings.
- Minimum 3-year follow-up to track syndrome evolution.
Main Results:
- 84% of patients had partial seizures; 10.7% had generalized seizures.
- 23 of 24 neonates with benign familial/non-familial neonatal convulsions presented with partial seizures.
- 41% of symptomatic neonatal epilepsies evolved into West syndrome, often preceded by symptomatic localization-related epilepsy.
Conclusions:
- Neonatal epilepsies frequently manifest as partial seizures, challenging current classifications.
- Age-dependent changes are characteristic of symptomatic neonatal epilepsies.
- Symptomatic localization-related epilepsy with transient West syndrome represents a distinct age-dependent epileptic syndrome.
Abstract:
Most neonatal seizures are occasional seizures and not true epilepsy. This study investigates seizure types of true neonatal epilepsies and their evolution with development. Seventy-five children with epilepsies of onset within 1 month of life, who were examined between 1970 and 1995, and whose seizure types could be confirmed with ictal EEG recordings, were studied. The patients were followed up for a minimum of 3 years and the evolution of epileptic syndromes was investigated. Sixty-three (84%) of 75 patients had partial seizures, while nine had generalized seizures, and only three had both generalized and partial seizures. Twenty-three of 24 neonates with benign familial or non-familial neonatal convulsions presented with partial seizures; these syndromes should not necessarily be categorized into generalized epilepsy as they are in the present International Classification. Age-dependent changes were a common feature of symptomatic neonatal epilepsies. Eighteen (41%) of 44 patients with symptomatic epilepsies of neonatal onset developed West syndrome in infancy. Fifteen (83%) of these 18 patients presented with symptomatic localization-related epilepsy in the neonatal period. In seven of these 15 patients, West syndrome was followed by localization-related epilepsy. Symptomatic localization-related epilepsy with transient West syndrome in infancy is another type of age-dependent epileptic syndrome.