Neonatal seizures: eyes open or closed?

Area of Science:

• Neonatal neurology
• Pediatric epilepsy
• Clinical neurophysiology

Background:

• Persistent eye closure during paroxysmal events is known to make seizures unlikely in infants.
• This observation has clinical implications for differentiating seizure activity from other events.

Purpose of the Study:

• To investigate whether persistent eye closure during paroxysmal events is also indicative of unlikely seizures in neonates.
• To evaluate the diagnostic utility of eye status during suspected seizures in newborns.

Main Methods:

• Retrospective review and classification of archived neonatal seizures from a video database.
• Inclusion criteria: electroclinical seizures only (excluding electrographic or non-EEG-correlated clinical seizures).
• Assessment of eye status (open or closed) during 131 electroclinical seizures in 46 neonates.

Main Results:

• Eyes were open in 115 (88%) of assessed seizures.
• Eyes were persistently closed in 10 seizures (8%).
• All 10 seizures with persistent eye closure were identified as clonic seizures.

Conclusions:

• Persistent eye closure during a suspected seizure event in a neonate makes an electroclinical seizure unlikely.
• The findings support the hypothesis that eye status can aid in the diagnosis of neonatal seizures.
• Further research may refine the use of eye closure as a clinical sign in neonatal neurology.