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How to Obtain Reliable Visual Event-related Potentials in Newborns
Published on: October 24, 2019
[Cases of video electroencephalogram: differential diagnosis in newborn infants]
Carlos Casas-Fernández1, Helena Alarcón-Martínez
1Servicio de Neuropediatria, Hospital General Universitario Virgen de la Arrixaca, Ctra. Murcia-Cartagena, El Palmar (Murcia), Spain. casascarlos@telefonica.net
Insights
Neonatal epilepsies present unique challenges due to immature central nervous systems. This study explores their distinct pathophysiology, clinical signs, and classification, highlighting the need for better differentiation in current epilepsy syndromes.
Area of Science:
- Neurology
- Pediatrics
- Neonatology
Context:
- Neonatal period presents unique neurological developmental stages.
- Epilepsies in newborns differ significantly from older children and adults.
- Gestational age influences the prevalence of neonatal epilepsy.
Purpose:
- To analyze the pathophysiology of neonatal seizures.
- To differentiate clinical manifestations of neonatal epilepsies.
- To discuss the classification and individuality of neonatal epileptic syndromes.
Summary:
- Neonatal epilepsies are characterized by specific pathophysiology and clinical presentations.
- Four main seizure types (subtle, tonic, clonic, myoclonic) are recognized.
- Current epilepsy classifications inadequately address neonatal epilepsies despite their distinct features.
Impact:
- Highlights the need for improved diagnostic criteria for neonatal seizures.
- Emphasizes the importance of considering gestational age in epilepsy assessment.
- Provides clinical examples to aid in understanding and diagnosing neonatal epilepsy.
Abstract:
This study addresses a number of general considerations on epilepsies and epileptic syndromes that develop in the neonatal period. The chronological limits of this stage of maturation are set out and the pathophysiology of the convulsive phenomenon during that period are briefly analysed. Furthermore, the differences that exist as a result of the incipient level of maturity of the newborn infant's central nervous system with regard to other ages, and obviously adults, are highlighted. Likewise, reference is made to the percentage values of this pathology, which even vary depending on the gestational age. The clinical expression has a personality that is very different from the other stages of maturation in children, with four predominant manifestations: subtle, tonic, clonic and myoclonic seizures, which have been universally accepted since they were first reported by Volpe. Epilepsies in the newborn infant are not sufficiently well differentiated in the different classifications of epilepsies and epileptic syndromes that have appeared in recent years, although they could well be, since they display enough significance and individuality for that to be so. Three clinical cases are reported, with the aid of video electroencephalographic findings, to illustrate some of the possible neonatal epileptic manifestations.
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Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
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