Evaluation of the Neonate with Seizures

Abstract

Neonatal seizures are common, occurring in 2 to 5 of 1,000 live births in the United States. The neonatal brain is thought to be predisposed toward seizures due to a combination of excessive excitatory and deficient inhibitory neuronal activity. The seizures tend to be focal or multifocal without secondary generalization, resulting in subtle seizure appearance. There are five main categories of neonatal seizures: focal clonic, focal tonic, myoclonic, subtle, and generalized tonic. An electroencephalogram is recommended to diagnose and treat neonatal seizures due to poor reliability of the clinical examination. Causes of neonatal seizures are broad, including trauma, structural brain anomalies, infections, metabolic disorders, drug withdrawal or intoxication, and neonatal epilepsy syndromes. Treatment of neonatal seizures involves management of cardiorespiratory status, correction of metabolic derangements, and antiepileptics as needed. The most common antiepileptics used in neonates are phenobarbital, levetiracetam, and fosphenytoin. The long-term risk of neurodevelopmental disability varies depending upon the etiology of neonatal seizures. Close attention to developmental milestones and neurology follow-up is recommended for all neonates with seizures. [ Pediatr Ann . 2020;49(7):e292–e298.]

“Fifth‐day fits” revisited: A literature review of benign idiopathic neonatal seizures and comparison with KCNQ2‐ and KCNQ3‐associated benign familial epilepsy syndromes

“…4,28 Standardized approaches to neonatal onset seizures recommend imaging (magnetic resonance imaging of the brain ideally), infectious studies, CSF analysis, serum electrolytes, and metabolic markers, and there is a growing impetus toward early molecular genetic testing (both targeted panels and broad-spectrum arrays such as whole-exome and whole-genome sequencing) for suspected genetic epilepsies. [29][30][31] Although imaging and initial laboratory evaluation can quickly identify and rule out most provoking causes of neonatal seizures, genetic testing for neonatal epilepsies and DEE can take anywhere from days to several weeks. Despite the inherent delay in diagnostic confirmation, there are clinical and electrographic features of neonatal seizure presentations that can aid in risk stratifying between likely benign/self-limited seizures and more severe genetic epilepsies/DEE.…”

“…Provoking brain injuries (such as hypoxic‐ischemic encephalopathy, vascular insults, meningoencephalitis, and toxic/metabolic derangements) and various identifiable etiologies of neonatal epilepsies (structural/anatomic, genetic, metabolic) collectively remain more prevalent than truly idiopathic BINS and therefore must be evaluated for thoroughly 4,28 . Standardized approaches to neonatal onset seizures recommend imaging (magnetic resonance imaging of the brain ideally), infectious studies, CSF analysis, serum electrolytes, and metabolic markers, and there is a growing impetus toward early molecular genetic testing (both targeted panels and broad‐spectrum arrays such as whole‐exome and whole‐genome sequencing) for suspected genetic epilepsies 29–31 …”