Pediatrics & Therapeutics
Open Access

Neonatal Seizures: Understanding and Managing Early Life Epileptic Events

Gary Stein^{* *}Correspondence: Gary Stein, Department of Anaesthesia and Critical Care, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London, UK, Email:

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Description

Neonatal seizures are a significant and alarming clinical issue, representing the most common neurological emergency in newborns. These seizures, occurring within the first 28 days of life, can be indicative of a wide range of underlying conditions and carry substantial implications for a child’s long-term neurological development. Early identification and appropriate management are important in mitigating potential adverse outcomes.

Understanding neonatal seizures

Neonatal seizures are often subtle and can manifest differently compared to seizures in older children and adults. These seizures can present as rhythmic movements, abnormal posturing, or even subtle changes in behavior such as staring or irregular breathing. Due to the immaturity of the neonatal brain, seizures might not always exhibit the classic convulsive activity seen in older individuals [1].

Etiology of neonatal seizures

The causes of neonatal seizures are diverse and can be broadly categorized into acute symptomatic and remote symptomatic etiologies.

Acute symptomatic seizures: These are the most common and are usually due to conditions that directly affect the neonatal brain. Common causes include:

Hypoxic-Ischemic Encephalopathy (HIE): Resulting from birth asphyxia, HIE is a leading cause of neonatal seizures [2].

Intracranial hemorrhage: Trauma during delivery or underlying clotting disorders can lead to bleeding within the brain.

Infections: Meningitis and encephalitis are significant contributors.

Metabolic disturbances: Hypoglycemia, hypocalcemia, and inborn errors of metabolism can provoke seizures.

Remote symptomatic seizures: These are associated with congenital or genetic conditions that predispose the neonate to seizures, such as:

Congenital malformations: Brain malformations can inherently predispose infants to seizures.

Genetic epilepsies: Some genetic disorders present with seizures as an early symptom.

Diagnosis and evaluation

Diagnosing neonatal seizures involves a combination of clinical observation, neuroimaging, and laboratory investigations.

Clinical observation: Careful monitoring and detailed description of seizure episodes are critical. Video EEG monitoring is the standard for identifying and characterizing neonatal seizures, as it allows for the correlation of electrical activity with clinical events.

Neuroimaging: Cranial ultrasound, MRI, and CT scans can help identify structural abnormalities, hemorrhages, or signs of hypoxic-ischemic injury [3].

Laboratory investigations: Blood tests to check for metabolic imbalances, infections, and genetic testing can provide valuable information about the underlying cause.

Management of neonatal seizures

Effective management of neonatal seizures requires addressing both the seizures themselves and the underlying cause.

Initial stabilization: Immediate management focuses on stabilizing the neonate, ensuring adequate airway, breathing, and circulation. Correcting metabolic disturbances such as hypoglycemia or electrolyte imbalances is often the first step [4].

Antiepileptic Drugs (AEDs): Phenobarbital is commonly used as the first-line treatment for neonatal seizures. Other medications like phenytoin, levetiracetam, and midazolam are also used based on the neonate’s response and the underlying etiology.

Treating the underlying cause: Identifying and treating the root cause of the seizures is critical. For example, antibiotics and antivirals are administered for infections, and specific treatments are provided for metabolic disorders.

Prognosis and long-term outcomes

The prognosis of neonatal seizures depends largely on the underlying cause and the effectiveness of the initial management. Seizures due to acute, treatable conditions such as hypoglycemia often have a better prognosis compared to those caused by genetic disorders or severe hypoxic-ischemic injury.

Long-term outcomes can include neurodevelopmental delays, cerebral palsy, and epilepsy. Early and aggressive intervention, along with regular follow-up, is essential for optimizing longterm outcomes. Developmental assessments and early intervention programs can help address potential delays and improve quality of life.

Preventive strategies

Prevention of neonatal seizures focuses on mitigating risk factors and providing optimal prenatal and perinatal care. Strategies include:

Prenatal care: Adequate prenatal care can help identify and manage conditions that might predispose to neonatal seizures, such as maternal infections or metabolic disorders.

Safe delivery practices: Ensuring safe delivery practices can minimize the risk of birth trauma and hypoxic events. This includes timely identification and management of labor complications [5].

Neonatal screening: Early screening for metabolic disorders and timely vaccination against infections like meningitis can prevent some of the underlying causes of neonatal seizures.

Conclusion

Neonatal seizures are a critical issue that demands prompt and precise intervention to prevent long-term neurological damage. Understanding the diverse etiologies, employing comprehensive diagnostic tools, and initiating early and effective management are key to improving outcomes for affected neonates. As research and clinical practices continue to evolve, the goal remains to enhance early detection, treatment, and prevention strategies, ultimately ensuring better health and developmental trajectories for these vulnerable patients.

References

1. Pisani F, Spagnoli C, Falsaperla R, Nagarajan L, Ramantani G. Seizures in the neonate: A review of etiologies and outcomes. Seizure.2021;85:48-56.

   [Crossref] [GoogleScholar] [PubMed]

2. Mizrahi EM, Clancy RR. Neonatal seizures: Early-onset seizure syndromes and their consequences for development. Ment Retard Dev Disabil Res Rev.2000;6(4):229-241.

   [Crossref] [GoogleScholar] [PubMed]

3. Sheth RD, Hobbs GR, Mullett M. Neonatal seizures. J Perinatol. 1999;19(1):40-43.

   [Crossref] [GoogleScholar] [PubMed]

4. Glass HC. Neonatal seizures: Advances in mechanisms and management. Clin Perinatol.2014;41(1):177-190.

   [Crossref] [GoogleScholar] [PubMed]

5. Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizures. Semin Fetal Neonatal Med. 2013;18(4):185-191.

   [Crossref] [GoogleScholar] [PubMed]