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Etiology of convulsions in neonatal and infantile period
Insights
This study investigated the causes of convulsions in 418 young children, finding postnatal factors most common. Seizure patterns in infancy often correlate with organic brain damage.
Area of Science:
- Pediatrics
- Neurology
- Clinical Medicine
Background:
- Convulsions in early childhood are a significant concern with diverse etiologies.
- Understanding the causes of neonatal seizures and infantile convulsions is crucial for diagnosis and management.
Purpose of the Study:
- To analyze the etiology and clinical characteristics of convulsions in children under two years of age.
- To investigate the correlation between seizure patterns, etiology, and neurophysiological findings.
Main Methods:
- Retrospective analysis of 418 cases of convulsions in children under two years old.
- Categorization of etiology into prenatal, natal, postnatal, and unknown causes.
- Correlation of seizure patterns, neuroimaging (Pneumoencephalography), and electroencephalography (EEG) findings with etiology.
Main Results:
- Postnatal factors (38%) were the most common etiology, followed by unknown causes (34%).
- Prenatal factors included cerebral malformations and congenital anomalies; natal factors were less common.
- In infancy, focal-unilateral convulsions and infantile spasms were associated with organic damage, while generalized seizures occurred in both organic and functional conditions.
Conclusions:
- The etiology of early-onset convulsions is multifactorial, with postnatal causes predominating.
- Specific EEG patterns are associated with certain etiologies like cerebral malformations and tuberous sclerosis.
- Seizure patterns in infancy provide clues to underlying organic brain damage.
Abstract:
1) Etiology of convulsions starting prior to two years of age was discussed in 418 cases. Neonatal seizures before 30 days old appeared in 86 cases (53 boys and 33 girls). Three hundred and thirty-two patients (172 boys and 160 girls) had convulsions in infancy. Twelve patients (9 boys and 3 girls) suffered from convulsions both in neonatal and infantile period. 2)Etiology of convulsions was prenatal in 67 cases (16%), natal in 49 cases (12%), postnatal in 158 cases (38%) and unknown in 144 cases (34%). Prenatal factors consisted of cerebral malformation (23 cases, 6%), associated physical minor anomaly such as cataracta or finger abomaly (11 cases, 3%), abnormal pernatal history (8 cases, 2%), congenital heart disease 3) cases, 1%), tuberose scleorsis (7 cases, 2%) and positive family history (13 cases, 3%). Postnatal causes included hypocalcemia or hypoglycemia (7 cases, 2%), brain tumors (3 cases, 1%), breath-holding spells (21 cases, 5%), febrile convulsion (44 cases, 11%), bathing (3 cases, 1%), afebrile colds (3 cases, 1%), purulent meningitis (17 cases, 4%), DPT immunization (10 cases 2%), vaccination (7 cases, 2%) and acute hemiplegia (10 cases, 2%). The group of unknown etiology were as fns (38 cases, 9%), epilepsy associated with interictal signs (23 cases, 6%), benign infantile convulsions (57 cases, 14%), neonatal convulsion of unknown etiology (12 cases, 3%) and miscellaneous categories (4%). 3) Pregnancy was abnormal in 53% of cases with cerebral malformation. Asphyxia at birth was noted in 43% of patients with tuberose sclerosis and in 35% of congenital cerebral abomaly. 4) Pneumoencephalographic examinations revealed midline anomaly in 50% of cerebral malformation. It was abnormal in all cases with tuberose sclerosis, head injury and epilepsy with interseizure neurological signs. 5) There were no correlations between the seizure pattern and the etiology in neonatal convulsion. In infancy, focal-unilateral convulsions and infantile spasms were frequently associated with organic damages. Generalized seizures were seen in organic lesions as well as functional ones although approximately half of the cases were febrile convulsion, benign infantile convulsion or breath-holding spell. 6) EEG features of cerebral malformation were asymmetrical or multifocal dischages in neonatal period and hypsarhythmia or focal-unilateral spike discharges in infancy. Tuberose sclerosis showed hypsarhythmia in infancy. In birth injury or cerebral anoxia, EEG mostly revealed focal-unilateral abnormality or suppression-burst activity in newborns and hypsarhythmia or focal features in infants. 7) The occurrence rate of neonatal seizures in autopsy cases with intracranial pathology was demonstrated. EEG with intravenous diazepam was useful to know pathophysiology of infantile spasms.