Neonatal onset seizures (first two months of life)
Seizures happen more frequently in the newly born than at any other stage in life. They occur in preterm neonates (babies born earlier than 40 weeks) somewhat more frequently than in full-term babies. Babies who have seizures in the first few days after delivery tend to have more severe outcomes than those whose seizures begin later in the neonatal period.
Neonatal seizures syndrome
Seizures in newborns differ from those in later life. They are often subtle and difficult to differentiate from other normal behaviors the baby might display. Of neonates with seizures, about 22 percent will have more than one form of seizure. However, one form usually predominates.
Symptoms
Among behaviors or symptoms that may be neonatal seizures are the following :
- Repetitive sucking
- Repeated extending of the tongue
- Continuous chewing
- Continuous drooling
- Long pauses in breathing (apnea)
- Rapid eye movements
- Blinking/fluttering of eyelids
- Fixation of gaze to one side
- Body aligned to one side
- Pedaling/stepping movements of legs
- Paddling/rowing movements of arms
- Rapid muscle jerks
Evaluation
Neonatal seizures syndrome
In contrast to children who are older, the outcome of seizures in newborns is influenced more by the cause than the frequency, severity, and how long the seizures continue. , t herefore, a prompt evaluation to identify and, if possible, treat the cause in newborns is essential. The problem is usually identifiable in most neonates, with less than one-third being diagnosed with an unknown cause.
The evaluation will begin with a careful history and physical examination by the doctor. Blood samples will be analyzed. If a metabolic cause is suspected additional blood analysis and urinalysis will occur. A spinal fluid analysis may be conducted if the cause still remains unknown.
Brain-wave patterns in the first weeks of life differ from those that come with later brain development, making EEG patterns in newborns difficult to interpret, nevertheless, an EEG will likely be obtained to confirm that the suspect behavior is associated with electrical discharges, a sign that helps determine the course of treatment.
Treatment
Neonatal seizures syndrome
Most seizures in newborns will be successfully treated with anticonvulsant medication, but newborns found to have seizures due to metabolic causes can often be treated with the missing nutrient, and seizures that are not associated with an electrical discharge may not require any treatment.
Among medications likely to be administered as first-line therapy are phenobarbital, phenytoin, diazepam and lorazepam. Others that might be used in treating neonatal seizures are lidocaine, carbamazepine, primidone, paraldehyde, clonazepam, valproate, and, in countries where it is available, vigabatrin. Vigabatrin, which is not available in the United States, is toxic to the eye and may cause loss of peripheral vision.
Newborns with seizures due to brain infection, hemorrhage, or operable anomalies or lesions, will receive surgical or other appropriate treatment .
Outcome
Neonatal seizures syndrome
The prognosis for infants with this syndrome depends largely on the amount of brain injury or abnormal development present. In general, newborns whose seizures have a metabolic cause do better than those with brain hemorrhage, infection or structural abnormality.
More than half of infants who experience seizures as newborns will go on to develop epilepsy at a later age.
Newborns with seizures related to brain injuries or developmental anomalies may have further complications, such as cerebral palsy, mental retardation, and other neurological deficits. These conditions result from the underlying brain damage and are not seizure related.