0% found this document useful (0 votes)
84 views26 pages

Neonatal Seizures

Download as pdf or txt
Download as pdf or txt
Download as pdf or txt
You are on page 1/ 26

NEONATAL SEIZURES

DR. MOINAK SEN SARMA


ASST. PROFESSOR
PAEDIATRICS
INTRODUCTION

• Most frequent of the overt


manifestations
of neurological disorders of newborn

• Recognising, determining etiology and


treating is important
PROBABLE MECHANISMS

1. Failure of Na - K pump secondary to


decreased adenosine triphosphate.
2. Increase in excitatory neurotransmitters
3. Decrease in inhibitory neurotransmitters
4. Membrane alteration - Increased Na
permeability
SEIZURE PATTERN
1. Subtle seizure: 50%of seizures in
newborn
Example: Tonic horizontal deviation of eyes
Repetitive blinking / fluttering of eyelids
Oro- buccal movements-chewing, lip smacking
Tonic posturing of a limb
Apnea
Swimming/ bycycling movements

2. Clonic - Focal / Multifocal


3. Tonic - focal / generalised
4. Myoclonic
JITTERINESS VS SEIZURES
Features Jitteriness Seizure
1. Occurrence Provocated by stimuli Spontaneous
Stretching joint
2. Cessation Passive flexion -
Gentle restraint
3. Rhythmicity Rhythmic oscillation Fast & slow
components
4. Frequency of jerks 5-6 / sec 2-3 / sec
5. Abnormal gaze / Nil Present
Eye movement
6. Autonomic disturbance
( Increase HR, BP) Nil Present
7. EEG Normal Abnormal
ETIOLOGY
A. Perinatal causes 1. Neonatal encephalopathy - 20-40%
of seizures
2. Intracranial hemorrhages- CNS
trauma, SAH, PVH, SDH
B. Metabolic
C. Infections
D. Developmental Problems
E. Drugs- Narcotic withdrawal, LA, Theophylline
F. Polycythemia
G. Focal infarcts
H. Hypertensive encephalopathy
I. Unknown(Idiopathic): 3-25%
METABOLIC CAUSES
1. Hypoglycemia
2. Hypocalcemia - Early / Late
3. Hypomagnesemia
4. Hypo / Hypernatremia
5. Pyridoxine dependency
6. Disorders of amino acid metabolism
7. Organic acidemia
8. Biotin responsive disorder
9. Peroxisomal / Mitochondrial / storage
disorders
Infections
1. Bacterial Meningitis
2. Viral infections
3. Toxoplasmosis
4. Syphilis
5. HIV
Developmental problems
– Cerebral Dysgenesis - Obvious /
microscopic
– Phakomatosis
ANTICONVULSANTS
Phenobarbitone
15 - 20mg / kg IV loading dose
3.5 - 5mg / kg / day maintenance dose
Phenytoin
15 - 20 mg / kg IV at 1mg / kg / min
4 - 8 mg / kg day maintenance dose
Midazolam 0.02 - 0.4 mg/kg IM
0.02 - 0.1mg/kg IV
0.06 - 0.4mg/kg/hr
Others Lorazepam, diazepam, Paraldehyde
TREATMENT
1. Optimise ventilation
Maintain CO, BP, Serum electrolytes & pH
2. Treat underlying diseases- Metabolic abnormalities,
meningitis, Narcotic withdrawal
3. Secure IV line
4. Glucose bolus - 5ml/kg 0f 10% Dx and maintenance
5. Pyridoxine dependency- 50mg IV
6. Calcium, Mg
7. Anticonvulsants
FOLLOW UP -
ANTICONVULSANTS
1. Stop all others except maintenance PB
2. Maintenance PB : 2wks - 2months
3. Risk of recurrence
Little: transient metabolic abnormalities
30-50% : HIE
High : Cortex malformations
PROGNOSIS
Normal Outcome: 56%
Neurological sequelae: 30%
Death : 15%
Chronic seizure disorder: 15-20%
Outcome depends on
1. Level of maturity
2. Etiology
3. Neurological examination
4. EEG / Imaging studies
NEONATAL INTENSIVE CARE UNIT
• NEONATAL TETANUS

You might also like