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Neonatal seizures and syndromes
1Department of Neurology, School of Medicine, and The M.I.N.D. Institute, University of California Davis, Sacramento 95817, USA. barry.tharp@ucdmc.ucdavis.edu
Insights
Neonatal seizures, affecting 1.8-5/1,000 live births, often accompany encephalopathies. Many seizures lack clinical or EEG signs, especially post-treatment, highlighting diagnostic challenges in newborns.
Area of Science:
- Neurology
- Neonatal Medicine
- Clinical Neurophysiology
Background:
- Neonatal seizures are a common complication of neonatal encephalopathies.
- They occur in 1.8-5/1,000 live births and stem from diverse conditions impacting brain function.
- A significant challenge is that seizures may not always present with obvious clinical or electroencephalogram (EEG) abnormalities.
Purpose of the Study:
- To provide a classification of neonatal seizures.
- To highlight the diagnostic difficulties, including non-convulsive seizures and those masked by treatment.
- To review specific neonatal epileptic syndromes.
Main Methods:
- Literature review focusing on neonatal seizures and encephalopathies.
- Analysis of seizure presentation, including clinical and EEG characteristics.
- Discussion of underlying etiologies, including genetic channelopathies and specific epileptic syndromes.
Main Results:
- Many abnormal behaviors in neonates lack ictal EEG patterns.
- Up to 50% of neonatal seizures may not present with abnormal clinical behavior, particularly after anticonvulsant therapy.
- Genetic disorders, such as potassium channelopathies, can cause benign familial seizures.
Conclusions:
- Neonatal seizures are complex and can be challenging to diagnose due to subtle or absent clinical and EEG manifestations.
- Understanding the diverse causes, including genetic factors and specific syndromes like Ohtahara syndrome, is crucial for effective management.
- Further research is needed to improve the detection and treatment of neonatal seizures, especially subclinical events.
Abstract:
Neonatal seizures frequently accompany neonatal encephalopathies. Seizures occur in approximately 1.8-5/1,000 live births in this country and are caused by virtually any condition that affects neonatal brain function. This review provides a simple classification of seizures and emphasizes that many abnormal intermittent behaviors in this age group are not accompanied by ictal EEG patterns. Additionally, < or =50% of neonatal seizures are not associated with abnormal clinical behavior. This is a common phenomenon, particularly after anticonvulsant treatment in which the clinical seizures are suppressed but electrographic seizures continue unabated. Seizures also may be caused by genetic disorders, several of which are benign, familial, and caused by channelopathies involving potassium channels. The review also discusses the epileptic syndromes seen in neonates, including early myoclonic encephalopathy, Ohtahara syndrome, pyridoxine dependency, and glucose transporter type 1 syndrome.