Neonatal seizures and encephalopathy

Overview & Definition

A neonatal seizure is the clinical or electrographic expression of abnormal, excessive neuronal discharge in the immature brain occurring within the first 28 days of life. Unlike seizures in older children, the great majority are provoked — they are an acute symptom of an underlying brain insult, not a manifestation of epilepsy — which is why the decisive clinical task is not to stop the movements but to find and treat the cause. [5]

Neonatal encephalopathy is the broader term for a disturbance of neurological function in the newborn: altered consciousness, abnormal tone, depressed or absent reflexes, autonomic dysfunction, feeding difficulty, and (often) seizures. Hypoxic-ischaemic encephalopathy (HIE) is the commonest cause of neonatal encephalopathy and the commonest provocation for neonatal seizures, so the two are deeply linked — an encephalopathic infant must be observed for seizures, and a seizing infant must be assessed for encephalopathy and its cause. [5] [10]

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1. [1]Azzopardi DV; Strohm B; Edwards AD; Dyet L; Halliday HL; Juszczak E; Kapellou O; Levene M; Marlow N; Porter E; et al Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med, 2009.PMID 19797281
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7. [7]Sharpe C; Reiner GE; Davis SL; Garcia M; Hardjec K; Ip K; Jiang P; Lai YC; Legido A; Molinaro M; et al Levetiracetam Versus Phenobarbital for Neonatal Seizures: A Randomized Controlled Trial. Pediatrics, 2020.PMID 32385134
8. [8]Shellhaas RA; Chang T; Tsuchida T; Scher MS; Riviello JJ; Abend NS; Nguyen S; Wusthoff CJ; Clancy RR The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol, 2011.PMID 22146359
9. [9]Nyman J; Mikkonen K; Metsäranta M; Stefanovic V; Wallin-Lundqvist E; Glinianaia SV; Toiviainen-Salo S; Vanhatalo S; Hallberg B; Hellström-Westas L Poor aEEG background recovery after perinatal hypoxic ischemic encephalopathy predicts postneonatal epilepsy by age 4 years. Clin Neurophysiol, 2022.PMID 36183624
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