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Neonatal Convulsion/ Seizure
Introduction• Neonatal Convulsion are common life- threatening
emergency in the newborn due to cerebral or biochemic abnormality.
• Preterm and LBW babies are more prone to this problem.
• Common cause of neonatal convulsion are hypoxic- ischemic encephelopathy (HIE), hypocalcemia, hypoglycemia, septicemia with meningitis and polycethemia.
Etiology • Developmental neurological problem- – Congenital hydrocephalus, microcephaly, cerebral
dsygenesis, etc.• Perinatal complication:- HIE, birth asphyxia, birth
injuries, intracranial hemorrhage.• Perinatal infections:- Meningitis, septicemia,
intrauterine infection( STORCH) • Metabolic problem:- Hypoglycemia, hypocalcaemia,
hypomagnesmia, Inborn errors of metabolism etc. • Drug:-
Type • Subtle
• Generalized tonic
• Multifocal clonic
• Focal clonic
• Myoclonic Seizures
Clinical Manifestation • About 50% of all neonatal seizures are subtle type,
which may manifest as eye movement – ( Blinking, Fluttering, deviation with jerking, eye
opening sustained with ocular fixation), – Orobuccolingual movements – Screaming – Rowing and pedalling, – Apneic spells – Bradycardia
Type Clinical manifestation Comments
Subtle
Eye: staring, deviation, blinking etcOral: chewing, sucking, lip smacking
Limbs: cycling, swimming rowingSystemic: apnoea, tachycardia, blood
pressure alterations
It may be difficult to differentiate subtle seizures from extremes of normal behaviour. Many subtle
seizures are thought to arise from the basal ganglia as a result of diminished cortical inhibition.
Further depression of the cortex with anticonvulsants may not alter
these seizures
ClonicUsually involve one limb or one side of the body
jerking rhythmically at 1 - 4 times per second.Consciousness usually preserved.
May be a clue to an underlying focal neuropathology eg haemorrhage or cerebral
infarction.
MyoclonicRapid isolated jerking of muscles.
May be focal or multifocal.
Seen in drug withdrawal (especially opiates). If it occurs during sleep then it
is probably ‘benign neonatal sleep myoclonus’. Can also occur in a very
severe form of encephalopathy.
Tonic
Sustained posturing of the limbs or trunk or deviation of the head. It may mimic decerebrate
or decorticate posturing. Only 30% have EEG correlates.
Often difficult to treat with anticonvulsants
Diagnostic Evaluation • Careful history with description of the convulsive
episodes along with detailed physical and neurological examination .
• Confirm diagnosis can be done by examination of – Blood, – Ph– urine and– CSF– Electrolytes – Amino acids etc.
Cont… Diagnostic Evaluation
• EEG
• CT Scan
• MRI
• ECG
• Serology for STORCH infection
• History of maternal drug addiction and infection
Management • Management of convulsive disorder depends
upon the identification cause. The management
mainly done with drug therapy and surgery, if
indicated.
• Emotional support, psychological rehabilitation
and vocational guidance are also importance
aspect of management.
Cont… Management
• Long term management may continue over 1 to 4
year and needs supervision and explanation for
treatment compliance.
• Drug therapy
• Diet therapy
• Surgical management
Drug therapy • Phenobarbital- 3 to 5 mg/kg/day in 1 or 2 divided
does and indicated in tonic- clonic, and febrile convulsion.
• Diphyenylhydantoin• Carbamazepine • Diazepam • Sodium valporate • Ethosuximide
Diet therapy • Ketogenic diet may be given to rise the seizure
threshold with calculated amount of proteins and
fats without carbohydrates.
Surgical management • Neurosurgery is indicated in some case of
convulsion disorders, espically in anatomical
lesion like brain tumor, hematoma and in
medically intractable seizure disorders.