Neonatal seizures and status epilepticus

Abstract

Neonatal seizures are common, often require EEG monitoring for diagnosis and management, may be associated with worse neurodevelopmental outcome, and can often be treated with existing anticonvulsants. A neonatal electrographic seizure is defined as a sudden, repetitive, evolving, and stereotyped event of abnormal electrographic pattern with amplitude of at least 2 μV and a minimum duration of 10 seconds. The diagnosis of neonatal seizures relies heavily on the neurophysiologist's interpretation of EEG. Consideration of specific criteria for the definition of a neonatal seizure, including seizure duration, location, morphology, evolution, semiology, and overall seizure burden, has utility for both the clinician and the researcher. The importance of EEG in the diagnosis and management of neonatal seizures, the electrographic characteristics of neonatal seizures, the impact of neonatal seizures on outcome, and tools to aid in the identification of neonatal seizures are reviewed.

Figure 1

This tracing contains rhythmic, non-evolving activity at Fp2-T4 and FP2-C4.

Figure 2

This tracing clusters of abnormal, repetitive, non-evolving sharps.

Figure 3

Localized onset of seizure in the right central region.

Figure 4

Bilateral independent seizures. The evolving rhythmic discharges in the right central region and left hemisphere occur independently occur independently.

Figure 5

Thirty seconds of EEG demonstrates an electrographic seizure. Two hours of quantitative EEG demonstrates seizures on amplitude-integrated EEG and density spectral array EEG.