Pediatric emergency medicine trisk 2564 2564

Seizures
CLINICAL PEARLS AND PITFALLS
Clinical seizures in the neonate are very subtle due to incomplete
myelination of the motor pathways; infants can present with tongue
thrusting, lip smacking, bicycling, or intermittent repetitive motions of a
single extremity or trunk; generalized clonic–tonic movements are
unlikely manifestations.
Neonatal seizures can be due to hypoglycemia and/or electrolyte
abnormalities, particularly from incorrect formula preparation.
Neonatal seizures may benefit from pyridoxine.
Current Evidence
Because of rapid, continued development of the neonatal brain, both clinical and
electroencephalographic (EEG) seizures of the newborn, vary dramatically from
the older child, so that recognizing the seizing infant remains a major challenge to
clinicians. Therefore, the true incidence of neonatal seizures remains unclear,
with reported ranges between 0.5% in term infants and 22% in preterm infants.
The effect of neonatal seizures on outcome is largely influenced by the
underlying disease process. However, regardless of etiology, it is believed that
seizures in the neonate can disrupt normal biochemical pathways responsible for
the development and maturation of the CNS. Prolonged neonatal seizures can
lower the seizure threshold in later life and are associated with learning and
memory impairments in adults with seizure disorders. Complicating outcome
studies of neonatal seizures is that many antiepileptic medications may contribute
to medication-induced brain injury and/or teratogenic effects on the brain
development, particularly with prolonged use.
Goals of Treatment
The primary goal of treatment is early recognition of neonatal seizures,
identification of the etiology, and control of the seizure as quickly as possible.
True seizure activity should be distinguished from more benign, nonepileptic
behaviors of newborns, such as tremors, jitteriness, or benign sleep myoclonus. If
the seizure is due to hypoglycemia or electrolyte anomalies, initial treatment

should be correction of the underlying metabolic abnormality. If antiepileptic
medications are used to treat seizures, it is important to also initiate EEG