Current neonatal seizure classification and approach to the newborn with seizure

Area of Science:

• Neonatal neurology
• Clinical electrophysiology

Background:

• Neonates face heightened seizure risk due to immature brains and susceptibility to injury.
• Provoked seizures, stemming from acute illness or brain injury, are most common.
• Diverse etiologies include hypoxic-ischemic encephalopathy, stroke, infections, metabolic, and genetic disorders.

Purpose of the Study:

• To summarize the current understanding and management of neonatal seizures.
• To highlight the importance of electrographic confirmation in seizure diagnosis.
• To advocate for evidence-based protocols in neonatal seizure management.

Main Methods:

• Review of current literature and clinical guidelines on neonatal seizures.
• Discussion of the 2021 International League Against Epilepsy classification update.
• Emphasis on electroencephalographic monitoring for diagnosis and treatment verification.

Main Results:

• Neonatal seizures often present with focal onset and are classified as motor, nonmotor, or sequential.
• Electrographic seizures without clinical correlation are increasingly recognized with advanced monitoring.
• Evidence-based protocols are crucial for timely evaluation and treatment.

Conclusions:

• Accurate diagnosis of neonatal seizures requires electrographic evidence.
• Prompt and evidence-based treatment is essential for optimal outcomes.
• Pyridoxine-dependent seizures should be considered in refractory cases.