Paroxysmal alteration in neurologic function (ie, behavioral, motor, or autonomic function)
CAUSES OF SEIZURES:
Occur within the 1st 24 h of life
Premature: generalized tonic type
Full term: multifocal clonic type
Both: accompanying subtle seizures
occur on the 2nd postnatal day
appears quiet well during the interictal period.
Periventricular or intraventricular hemorrhage
subtle seizures, decerebrate posturing, or generalized tonic sizures
focal seizures and focal cerebral sign
frequently in IUGR and infant of diabetic
LBW infants, IDMs, asphyxiated infants.
improper fluid management
result of SIADH
excessive use of sodium bicarbonate
incorrect dilution of concentrated formula
Pyridoxine dependency: resistant to
anticonvulsant, born with meconium
staining, asphyxiated infants.
Amino acid disorders: hyperammonemia
and acidosis are commonly present.
Bacterial infection: group B streptococcus, E. coli, L. monocytogenes.
Nonbacterial infection: toxoplasmosis, herpes simplex, cytomegalovirus, rubella, coxsackie B viruses.
Passive addiction from the mother
Analgesic: heroin, methadone
Sedative-hypnotics: secobarbital, alcohol
More common in premature
Eyelid blinking or fluttering
Sucking, smacking, or drolling
‘Swimming’, ‘rowing’, or ‘pedalling’ movements
Common in full term
Focal seizures: well localized, rhythmic, slow, jerking movement on one side of the body.
Multifocal siezures: several body parts seize in a sequential (eg, left arm jerking followed by right leg jerking)
Occur primarily in premature infants
Focal seizures: sustained posturing of a limb, asymmetric posturing of the trunk or neck, or both
Generalized seizures: tonic extension of both upper and lower extremities (decerebrate posturing), tonic flexion of the upper extremities with extension of lower extremities (decorticate posturing)
Both in full-term and premature
Characterized by single or multiple syncronous jerks.
Focal seizures: involve the flexor muscles of an upper extremity.
Multifocal seizures: asyncrhonous of several
parts of the body.
Generalized seizures: bilateral jerks of flexion of the upper and sometimes the lower extremities.
Maternal drug history
General: gestational age, blood pressure, presence of skin lession, presence of hepatosplenomegaly.
Notation of the seizure pattern
Spinal fluid examination
USG of the head
CT Scanning of the head
10% dextrose in water, 2-4 mL/kg/IV followed by 6-8 mg/kg/min by continious IV infusion.
Slow IV infusion of Ca Gluconate
Phenobarbital as a drug of choice
Diazepam (Valium): not been used extensively
Lorazepam (Ativan): quite effective and save
IV midazolam and oral carbamazepin
Paraldehyde: give rectally
DURATION OF ANTICONVULSANT THERAPY
Has not been established
Some clinicians: prolonged periode
Others: stopping after seizure have been absent for 2 weeks.
Modern NICU Mortality rate ↓ from 40 to 20%.
Neurologic sequele are still in 25-35% of cases
Hypocalcemic convulsions : excellent prognosis
Varies with the cause.
Symptomatic hypoglycemia: 50% risk of death
Asphyxiated infants: 50% change of poor outcome.
17% of patient have recurrent seizures later in life.