Neonatal seizures: advances in mechanisms and management

Abstract

Seizures occur in approximately 1 to 5 per 1000 live births and are among the most common neurologic conditions managed by a neonatal neurocritical care service. There are several, age-specific factors that are particular to the developing brain, which influence excitability and seizure generation, response to medications, and impact of seizures on brain structure and function. Neonatal seizures are often associated with serious underlying brain injury such as hypoxia-ischemia, stroke, or hemorrhage. Conventional, prolonged, continuous video electroencephalogram is the gold standard for detecting seizures, whereas amplitude-integrated EEG is a convenient and useful bedside tool.

Keywords: Brain injury; Developmental disability; Electroencephalography; Epilepsy; Infant, newborn; Magnetic resonance imaging; Neurocritical care; Seizures.

Figure 1

Amplitude-integrated EEG (left) and EEG (right) from a term male with multiple intracranial hemorrhages and seizures that were refractory to phenobarbital 40mg/kg and fosphenytoin 30mg/kg, and abated after 60mg/kg levetiracetam. aEEG and EEG are recorded from a single machine at the bedside. Data are displayed differently for different users: the bedside team sees the aEEG display at left, which shows long term trends and allows a quick review of suspicious segments of EEG. The neurophysiologist can confirm the seizures through the review of conventional, neonatal montage EEG.