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Neonatal Seizures
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Learning Objectives
1. Define seizures and differentiate
between epileptic and non-epileptic
seizures.
2. Know the incidence of neonatal seizures.
3. Describe the four types of seizures and
their clinical pictures.
4. Identify benign moements that are notseizures.
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Learning Objectives (cont)
!. "ist the causes of neonatal seizures#
both common and less common
etiologies.
$. Diagnose neonatal seizures.
%. &reat neonatal seizures.
'. Inform parents of the neonate(s
prognosis.
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)eizures are transient disturbances in
brain function manifesting as episodicimpairments in consciousness in
association with abnormal motor or
automatic actiity.
Definition of Seizure
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Epileptic and Non-Epileptic
Seizures*pileptic seizures originate from the
cortical neurons and are associated
with **+ changes.,on-epileptic seizures are initiated in
the subcortical area and are not usually
associated with any **+ changes.- prooed by stimuli and ameliorated
by restraint and body repositioning.
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Incidence of Neonatal Seizures
&he oerall incidence is .!/ of all term
and preterm neonates.
&he incidence is higher in preterm
neonates 03./ if gestational age 3wees.
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Tpes and !linical "resentations
of Neonatal Seizures#our tpes of seizures are fre$uentl
encountered in neonates%
Tonic Seizures
!lonic Seizures
&oclonic Seizures
Subtle (#rag'entar) Seizures
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Tonic Seizures
Tonic seizures can be eiter generalized or focal
*eneralized tonic seizures%
- ainly manifest in preterm neonates 0 2!grams.
- &onic fle5ion or e5tension of the upper
e5tremities# nec# or trun and are associated
with tonic e5tension of the lower e5tremities.
- In '!/ of cases are not associated with any
autonomic changes such as increases in heart
rate or blood pressure# or sin flushing.
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#ocal Tonic Seizures6resent with asymmetrical posturing of
one of the limbs or trun or with tonic
head or eye deiation.
ostly occur with diffuse central
nerous system disease andintraentricular hemorrhage.
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!lonic Seizures
7onsist of slow 01-3 8minute rhythmic9ering moements of the e5tremities.
&hey may be focal or multi-focal. *achmoement is composed of a rapidphase followed by a slow one.
7hanging the position or holding the
moing limb does not suppress themoements. &hey are commonly seenin full-term neonates :2! grams
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!lonic Seizures(cont)
&here is no loss of consciousness and
they are associated with focal trauma#
infarction or metabolic disturbances.
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&oclonic Seizures
yoclonic seizures can be focal# multifocal or generalized.
;ocal myoclonic seizures typicallyinole the fle5or muscles of thee5tremities.
ulti-focal myoclonic seizures presentas asynchronous twitching of seeralparts of the body.
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&oclonic Seizures(cont)
+eneralized myoclonic seizures
present as massie fle5ion of the headand trun with e5tension or fle5ion of
the e5tremities. &hey are associated
with diffuse 7,) pathology.
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Subtle (#rag'entar) Seizures
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Subtle (#rag'entar) Seizures(cont)
Drooling# sucing or chewing
moements.
>pnea or sudden changes in respiratory
patterns.
?hythmic fluctuations in ital signs.
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+enign &ove'ents tat are
Not Seizures
,itteriness
Sleep apnea
Isolated sucing 'ove'ents
+enign neonatal sleep
'oclonus
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,itteriness
,itteriness is often 'isdiagnosed as
clonic seizures !linicall te differ
fro' clonic seizures in te follo.ingaspects%
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,itteriness (cont)
&he fle5ion and e5tension phases are e@ualin amplitude.
,eonates are generally alert# with noabnormal gaze or eye moements.
6assie fle5ion or repositioning of the limbdiminishes the tremors. &remors are
prooed by tactile stimulation# though theymay be spontaneous.
,o **+ abnormalities.
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often seen in neonates with
hypoglycemia# drug withdrawal#
hypocalcemia# hypothermia and in0)+> neonates.
spontaneously resole within few wees.
,itteriness (cont)
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Sleep /pnea
,ot associated with abnormalmoements and is usually associated
with bradycardia.
Ahen seizures are present with apnea
abnormal moements# tachycardia andincreased blood pressure are present aswell.
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Isolated Sucing
&ove'ents
?andom# infre@uent and not wellsustained sucing moements are not
seizures.
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+enign Neonatal Sleep
&ove'ents 6redominantly seen in pretermneonates during sleep. &hey can be
focal# multi-focal# or generalized. &heydo not stop with restraint.
resole spontaneously within a few
minutes and re@uire no medication.
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+enign Neonatal Sleep
&ove'ents (cont)&hey differ from myoclonic seizures in
the following=
can be triggered by noise or motion.
suppressed by the waing state.
not associated with any autonomic
changes.
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&ost !o''on !auses of
SeizuresBI*
Infections 0&C?7B# meningitis#
septicemia
Bypoglycemia# hypocalcemia#
hypomagnesemia
7,) bleed 0intraentricular# subdural#
trauma# etc.
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Less !o''on !auses of
Seizures 7ongenital brain anomalies
Inborn errors of metabolism
aternal drug withdrawal 0heroin#barbiturates# methadone# cocaine# etc.
Kernicterus
6yrido5ine 0$ dependency# and
hyponatremia
more than one underlying cause
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Diagnosis of Seizures
Cbtain a good maternal and obstetric
history
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Laborator Investigations
"ri'ar tests
lood glucose
lood calcium and magnesium
7omplete blood count# differential leuocytic
count and platelet count
*lectrolytes
>rterial blood gas 7erebral spinal fluid analysis and cultures
lood cultures
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Laborator Investigations(cont)
&C?7B titers# ammonia leel# headsonogram and amino acids in urine.
**+,ormal in about 183 of cases
7ranial ultrasound
;or hemorrhage and scarring
7& &o diagnose cerebral malformations and
hemorrhage
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&anage'ent of Seizures
anagement goals
>chiee systemic homeostasis0airway# breathing and circulation.
7orrect the underlying cause if
possible.
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&edical &anage'ent of
Seizures 1/ de5trose solution 02cc8g IE empirically to
any seizing neonate.
7alcium gluconate 02mg8g IE# if
hypocalcemia is suspected .
agnesuim sulfate !/# .2ml8g or 2ml *@8g.
>ntibiotics in suspected sepsis.
In pyrido5ine dependency gie pyrido5ine !mgIE as a therapeutic trial. )eizures will stop
within minutes .
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Stopping Seizures .it
/nticonvulsants
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Stopping Seizures .it
/nticonvulsants (cont)
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Stopping Seizures .it
/nticonvulsants (cont)
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"rognosis
est prognosis with=
Aorse prognosis
with=
)e@uelae=
Bypocalcemia 6yrido5ine dependency )ubarachnoid
hemorrhage
Bypoglycemia>no5ia rain malformation
7hronic seizures 1!-2/
ental retardation
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TERIMAKASIH