Apneic seizures in the newborn.
ABSTRACT Electroclinical features of convulsive apnea and its relation to the behavioral state were described on the basis of polygraphic recordings from 21 newborns with various underlying disorders, including perinatal anoxia, purulent meningitis, and intracranial bleeding. The most frequent ictal discharges were rhythmic alpha waves, but other types of discharges, such as repeated sharp waves, rhythmic theta waves, delta waves, and repeated paroxysmal wave complexes, were also frequently seen. The area where the ictal discharges initially occurred or were most prominent was the temporal area, suggesting the limbic origin of apneic seizures. In more than half of the cases, the sleep cycle was abolished. In those cases where the sleep cycle was preserved, the seizures occurred most frequently in active sleep, but never in quiet sleep.
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ABSTRACT: Intracranial hemorrhage is a common cause of neonatal seizures in full-term infants. However, only some infants with intracranial hemorrhage come to clinical attention. A right temporal lobe hemorrhage with resulting apneic seizures was described previously in one neonate. In this case report, we review three full-term male neonates with no significant perinatal complications who presented with apneic events and temporal lobe hemorrhage. One neonate had apnea as the sole manifestation of a seizure that was confirmed electrographically. One neonate had motor manifestations of seizures, in addition to apnea, that were confirmed as seizures electrographically. The third neonate had pure apneic events before initiation of electroencephalogram monitoring which were presumed to be seizures, because the electroencephalogram demonstrated epileptiform abnormalities. At follow-up, all three children were neurodevelopmentally normal. This case report emphasizes that, although uncommon, full-term neonates may present with apnea as the initial manifestation of temporal lobe hemorrhage. Because apnea could be a manifestation of a seizure, continuous electroencephalogram monitoring should be considered in a full-term neonate with unexplained apnea.Pediatric Neurology 12/2007; 37(5):366-70. · 1.42 Impact Factor
Article: Sleep and epilepsy in neonates.[Show abstract] [Hide abstract]
ABSTRACT: In clinical practice, the association between sleep and epilepsy has been increasingly observed in adults and during childhood. The aim of this article is to verify the relationship between sleep and epilepsy in the neonatal period in order to identify evidence and mechanisms to explain how epilepsy or neonatal seizures might disrupt sleep and how sleep might influence seizure occurrence and epilepsy during this age span. Literature review with search of PubMed database using the key words neonatal seizures and sleep. The complex processes of cortical maturation are closely related to the regulation of sleep-wakefulness cycles. Sleep regulation in the context of neonatal seizures is frequently abnormal, and these alterations may be a result of the maladaptative plasticity of neuronal networks. Furthermore, in this situation altered connectivity might also be associated with other expressions of neurological dysfunction such as cognitive and behavioral problems. EEG background abnormalities and higher frequency of discharges are often associated with disrupted sleep organization. The outcome of newborns with seizures where sleep organization is undifferentiated seems to be more unfavorable.Sleep Medicine 08/2010; 11(7):665-73. · 3.49 Impact Factor
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ABSTRACT: Recently, amplitude-integrated EEG (aEEG) has been increasingly used and proved useful in neonatal intensive care units (NICU) for the management of neonatal seizures. It does not replace, but is supplementary to standard EEG. This article reviews some of findings obtained with standard EEGs, and tries to interpret them with recent findings in the field of basic science. Seizures mainly occur in active-REM sleep in neonates. This is in sharp contrast to those in older children and adults, in whom epileptic seizures occur mainly in NREM sleep. This may be explained by neurotransmitter effects on sleep mechanisms of the neonatal brain that are different from those of older individuals. When all clinical seizures have no electrical correlates, they are non-epileptic, but when the correlation between clinical seizures and frequent electrical discharges are inconsistent, they should rather be considered epileptic, reflecting progression of status epilepticus causing electro-clinical dissociation. Electro-clinical dissociation is not a characteristic of neonatal seizures per se, but a feature of prolonged status epilepticus in adults as well as children. It occurs when prolonged status epilepticus itself causes a progressively severe encephalopathy, or when status occurs in the presence of a severe underlying encephalopathy. In neonates without pre-existing brain damage, frequent seizures per se may cause mild depression characterized by the loss of high voltage slow patterns, an important constituent of slow wave sleep reflecting cortico-cortical connectivity. Mild depression only in the acute stage is not associated with neurological sequelae, but previously damaged brain may be more vulnerable than normal brain.Brain & development 01/2014; · 1.74 Impact Factor