Epilepsies and epileptic syndromes starting in the neonatal period

As seizures in the neonatal period have generally been identified only by direct clinical observation, there is frequently a lack of objectivity as to whether seizures are categorized as epilepsies or non-epilepsies. A major characteristic of neonatal seizures is electro-clinical dissociation and some electro-graphic seizures do not produce clinical symptoms. It is difficult to correctly identify real epilepsies or epileptic syndromes in the neonatal period without ictal electroencephalogram (EEG). Some epileptic syndromes starting in the neonatal period such as early myoclonic encephalopathy, Ohtahara syndrome, or migrating partial seizures in infancy are categorized as malignant epilepsies. A suppression-burst EEG pattern (SBP) is usually seen in neonates with serious brain damage, malignant epileptic syndromes or other neurological conditions. However SBP has not been consistently defined in the literature. We review malignant epilepsies and benign familial and non-familial neonatal seizures starting in the neonatal period and propose the characteristics of SBP in Ohtahara syndrome. Epileptic encephalopathies with SBP in the neonatal period are known to evolve into relatively few types of epileptic syndromes. We emphasize the importance of ictal EEG for diagnosis and treatment of malignant epilepsies and epileptic syndromes in the neonatal period.