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43 - Neonatal seizures: an expression of fetal or neonatal brain disorders

from Section 5 - Management of the depressed or neurologically dysfunctional neonate

Published online by Cambridge University Press:  12 January 2010

By
Mark S. Scher
Edited by
David K. Stevenson ,
William E. Benitz ,
Philip Sunshine ,
Susan R. Hintz  and
Maurice L. Druzin
David K. Stevenson
Affiliation:
Stanford University School of Medicine, California
William E. Benitz
Affiliation:
Stanford University School of Medicine, California
Philip Sunshine
Affiliation:
Stanford University School of Medicine, California
Susan R. Hintz
Affiliation:
Stanford University School of Medicine, California
Maurice L. Druzin
Affiliation:
Stanford University School of Medicine, California
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Summary

Introduction

Neonatal seizures are one of the few neonatal neurological conditions that require immediate medical attention. While prompt diagnostic and therapeutic plans are needed, multiple challenges impede the physician's evaluation of the newborn with suspected clinical and electroencephalographic (EEG) manifestations of neonatal seizures, which vary dramatically from those in older children. Recognition of the seizure state remains the foremost challenge to overcome. This dilemma is underscored by the brevity and subtlety of the clinical repertoire of the neonatal neurological examination.

Basic issues still remain regarding the recognition and treatment of neonatal seizures (Table 43.1). Which newborns with seizures to treat, and how to treat them, continues to occupy much discussion and controversy in written and oral presentations. While clinical seizures remain a common occurrence in neonatal intensive care settings, with an incidence as high as 2.6/1000 live births for term infants and 30–130/1000 live preterm births, increasing use of bedside EEG monitoring has resulted in the growing recognition that the incidence of seizures may be even higher. Yet the “who” question in the algorithm to diagnose and treat neonatal seizures includes a heterogeneous cohort of newborns who may present throughout the neonatal period (i.e., 30 days post-term). The manner of clinical presentation will reflect alternative diagnostic explanations for seizure recurrence based on timing, etiology, or brain region of injury. Presentation may imply part of a longer-standing encephalopathic process prior to and/or during parturition in some newborns.

Type
Chapter
Information
Fetal and Neonatal Brain Injury , pp. 499 - 526
Publisher: Cambridge University Press
Print publication year: 2009

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