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Seizures in the neonatal intensive care unit of the 1980s. Types, Etiologies, Timing
G Calciolari1, J M Perlman, J J Volpe
1Department of Pediatrics, Washington University School of Medicine, Children's Hospital, St. Louis, MO 63110.
Insights
Subtle and multifocal clonic seizures were most common in newborns. Hypoxic-ischemic encephalopathy was the leading cause, often presenting within the first two days of life.
Area of Science:
- Neonatal Neurology
- Pediatric Epilepsy
Background:
- Neonatal seizures are a significant concern, requiring understanding of their types, causes, and timing.
- Previous studies have characterized neonatal seizures, but ongoing review is essential for current populations.
Purpose of the Study:
- To analyze the distribution of clinical seizure types in newborns.
- To identify the common etiologies of neonatal seizures.
- To explore the relationship between seizure etiology and the timing of seizure onset.
Main Methods:
- Retrospective review of 150 newborns with seizures from 1982 to 1987.
- Classification of seizures into subtle, multifocal clonic, generalized tonic, focal clonic, and myoclonic types.
- Analysis of causative etiologies and their correlation with seizure onset.
Main Results:
- Subtle seizures (65%) and multifocal clonic seizures (54%) were the most prevalent seizure types.
- Hypoxic-ischemic encephalopathy was the predominant etiology (65%) in both preterm and term infants.
- Seizures related to hypoxic-ischemic encephalopathy typically occurred within the first two days of life (90%).
Conclusions:
- Subtle and multifocal clonic seizures are characteristic of neonatal seizures.
- Hypoxic-ischemic encephalopathy is a major cause of neonatal seizures, often presenting early.
- Understanding seizure types and etiologies aids in timely diagnosis and management of neonatal seizures.
Abstract:
A retrospective review was taken of 150 newborns with seizures evaluated at the same medical center and by the same investigator(s) from 1982 to 1987. The aims of the study were to determine in this current population the distribution of clinical seizure types, the distribution of causative etiologies, and the relation of etiology to the timing of onset of the seizures. Seizures were classified as subtle, multifocal clonic, generalized tonic, focal clonic, and myoclonic. Subtle (65% of total) and multifocal clonic seizures (54% of total) were the most common seizure types. Subtle seizures usually occurred in combination with other seizure types. Only one seizure type was related to gestational age, i.e., focal clonic seizures in the term infant. Hypoxic-ischemic encephalopathy (65% of total) was by far the most common etiology in both preterm and term infants. Seizures with hypoxic-ischemic encephalopathy occurred characteristically early in the neonatal period, i.e., 90 percent in the first 2 days of life. Moreover, 80 percent of all seizures in the first 2 days of life were related to hypoxic-ischemic encephalopathy.