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.