From abnormal fetal movements to neonatal seizures: A literature review

Fetal seizures (FS) are underestimated and underdiagnosed events with a poor prognosis that could precede neonatal seizures. FS diagnosis could be clinical or by means of ultrasound. FS causes are heterogenic. After a PubMed, Google Scholar and SCOPUS research, aimed to find publications concerning FS, we selected 23 studies, mainly case reports with literature reviews, for a total of 29 patients. We evaluated the method of diagnosis, gestational age at diagnosis of FS, FS etiology, time of etiological diagnosis, fetal/neonatal outcome and possible therapeutic options. Fetal seizures were mainly felt by the mother (20/29 cases, 69 %) or diagnosed by fetal ultrasound (17/29 cases, 58.6 %). When seizures were felt by the mother, the gestational age of the fetal seizures was comprised from 20 to 40 week (average 31.3 weeks); the range of weeks when fetal seizures were detected by ultrasound ranged from 13 to 41 weeks (average 29.3 weeks). Among the etiologies, the most frequent were Pyridoxine dependent epilepsy and arthrogryposis multiplex congenita (4/29 each, 13.8 %), followed by fatal infantile olive-ponto-cerebellar hypoplasia 3/29, 10.3 %). The outcome of the most of patients was severe, with neonatal death occurring in 12/29 (41.4 %), therapeutic abortion in 5/28 (17.2 %); death occurred later in infancy in 3/29 (10.3 %), while 8/29 (31 %) presented psychomotor delay. FS may be a prenatal sign of fetal neurological impairment. Their knowledge is crucial because an early diagnosis allow an appropriate management of pregnancy, and an early anti-convulsant treatment after birth. However, in the reported cases, the prognosis was frequently poor.