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Isolated ictal apnea in neonatal age: Clinical features and treatment options. A systematic review
Raffaele Falsaperla1, Maria Chiara Consentino2, Giovanna Vitaliti3
1Neonatal Intensive Care Unit [NICU], AOU "Rodolico - San Marco", PO "San Marco", University of Catania, Catania, Italy; Unit of Pediatrics and Pediatric Emergency, AOU "Rodolico - San Marco", PO "San Marco", University of Catania, Catania, Italy.
Insights
Ictal apnea (IA) in neonates is a challenging sign of neurological disorders. Phenobarbital is effective in most cases, but further research is needed for diagnosis and treatment.
Area of Science:
- Neonatal Neurology
- Pediatric Epilepsy
- Autonomic Seizures
Background:
- Apnea is a significant challenge in autonomic seizures, sometimes being the sole indicator of a neurological disorder.
- Ictal apnea (IA) requires further description and understanding for effective clinical management.
Conclusions:
- Limited data and inconsistent reporting hinder a definitive understanding of IA.
- Increased attention and the use of EEG/aEEG are recommended for diagnosing unexplained apnea in neonates.
Background:
Among autonomic seizures apnea still represent a challenge for physicians, and it might constitute the only isolated sign of neurological disorder. The aim of this review is to describe ictal apnea (IA) and its treatment options.
Methods:
MeSH and keywords were combined: "neonatal seizures", "ictal neonatal apnea", "apneic seizures". All identified papers were screened for neonatal seizures titles and abstracts; case reports describing patients with IA as an isolated manifestation of neonatal seizures were included.
Results:
Eight studies including a total of 13 patients were identified. Among 13 patients, 9 were full-term and 4 were preterm neonates. All patients developed IA within twenty-one days from birth. Etiologies of seizures included: temporal lobe hemorrhage (3 pt), occipital stroke (1 pt), hypoxic-ischemic encephalopathy (HIE) (1 pt), parasagittal injury (1 pt), 18 trisomy (2 pt). Five patients showed no structural CNS alterations. Ten patients had the ictal focus localized in the temporal lobe; the occipital lobe was the second most involved site. Phenobarbital was administered in 76 % of cases with IA (10 pt), and showed efficacy in 74 % of them; 2 required a second anti-epileptic drug (AED) to reach seizure control. Levetiracetam was given to 11 % (2 pt) successfully. Only one was treated with midazolam and one did not require any anticonvulsant.
Conclusions:
Not homogeneous data and paucity of isolated IA currently reported in literature limits agreement about definition, management and treatment of entity, however an ever-growing attention is needed, and EEG/aEEG, despite their possible controversies in the diagnosis, should be performed to investigate unexplained forms of apnea.
