Neonatology Division

Department of Child Health Medical School

University of Sumatera Utara
 DEFINITION

Paroxysmal alteration in neurologic

function (ie, behavioral, motor, or
autonomic function)

INCIDENCE
Range from 1.5 in 1000 to 14 in
1000
live births
 CAUSES OF SEIZURES

1. PERINATAL ASPHYXIA
Most common
Occur within the 1st 24 h of life
Premature: generalized tonic type
Full term: multifocal clonic type
Both: accompanying subtle seizures
 CAUSES OF SEIZURES
2. INTRACRANIAL HEMORRHAGE
Subarachnoid hemorrhage
- 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
 CAUSES OF SEIZURES
Subdural hemorrhage
- focal seizures and focal cerebral sign

3. METABOLIC DISTURBANCE
Hypoglycemia
- frequently in IUGR and infant of diabetic
mother (IDMs)
Hypocalcemia
- LBW infants, IDMs, asphyxiated infants.
 CAUSES OF SEIZURES
Hyponatremia
- improper fluid management
- result of SIADH
Hypernatremia
- dehyeration
- excessive use of sodium bicarbonate
- incorrect dilution of concentrated formula
 CAUSES OF SEIZURES
Other
- Pyridoxine dependency: resistant to
anticonvulsant, born with meconium
staining, asphyxiated infants.
- Amino acid disorders: hyperammonemia
and acidosis are commonly present.
 CAUSES OF SEIZURES

4. INFECTIONS
Bacterial infection: group B streptococcus,
E. coli, L. monocytogenes.
Nonbacterial infection: toxoplasmosis,
herpes simplex, cytomegalovirus, rubella,
coxsackie B viruses.
 CAUSES OF SEIZURES
5. DRUG WITHDRAWAL
- Passive addiction from the mother
- Analgesic: heroin, methadone
- Sedative-hypnotics: secobarbital, alcohol

6. TOXINS
 CLINICAL PRESENTATION
1. SUBTLE SEIZURES
More common in premature
Eyelid blinking or fluttering
Sucking, smacking, or drolling
Swimming, rowing, or pedalling
movements
Apneic spels
 CLINICAL PRESENTATION
2. CLONIC SEIZURES
Common in full term
Two types:
- 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)
 CLINICAL PRESENTATION
3. TONIC SEIZURES
Occur primarily in premature infants
Two types:
- 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)
 CLINICAL PRESENTATION
4. MYOCLONIC SEIZURES
Both in full-term and premature
Characterized by single or multiple syncronous
jerks.
Three types:
- 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.
 DIAGNOSIS
1. HISTORY
Family history
Maternal drug history
Delivery

2. PHYSICAL EXAMINATION
General: gestational age, blood
pressure, presence of skin lession,
presence of hepatosplenomegaly.
 DIAGNOSIS
- Neurologic evaluSerumation
- Notation of the seizure pattern

3. LABORATORY STUDIES
- Serum chemistries
- Spinal fluid examination
- Metabolic disorders
 DIAGNOSIS
4. RADIOLOGIC STUDIES
- USG of the head
- CT Scanning of the head

5. OTHER STUDIES
- EEG
 MANAGEMENT
1. HYPOGLYCEMIA
10% dextrose in water, 2-4 mL/kg/IV
followed by 6-8 mg/kg/min by continious
IV infusion.

2. HYPOCALCEMIA
Slow IV infusion of Ca Gluconate
 MANAGEMENT
2. ANTICONVULSANT THERAPY
Phenobarbital as a drug of choice
Phenytoin (Dilantin)
Pyridoxine
Diazepam (Valium): not been used
extensively
Lorazepam (Ativan): quite effective and
save
IV midazolam and oral carbamazepin
Paraldehyde: give rectally
 MANAGEMENT
4. DURATION OF ANTICONVULSANT
THERAPY
Has not been established
Some clinicians: prolonged periode
Others: stopping after seizure have been
absent for 2 weeks.
 PROGNOSIS
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.