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: 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 05/2014; DOI:10.1016/j.braindev.2014.01.016 · 1.54 Impact Factor
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    ABSTRACT: Neonatal seizure is the most frequent clinical manifestation of central nervous system dysfunction in the newborn. It is defined as a paroxysmal alteration in neurologic function that include motor, behavior and/or autonomic functions occurring in the first 28 days after birth of a term neonate or before 44 weeks of gestational age in a preterm infant. Seizures in the presence of encephalopathy are the most important clinical pattern of an acute cerebral insult in the immature brain. Chronic epileptic disorders very rarely may have their onset in the neonatal period and may persist well into infancy and later childhood. Structural brain defects and metabolic disorders constitute a substantial proportion of this group. Ictal EEG recordings remain the gold standard for the accurate identification of neonatal seizures of cortical origin and for the distinction from non-epileptic paroxysmal events. This review focuses on the electroclinical patterns of neonatal seizures and epilepsies with an emphasis on the classification and terminologies. The current therapeutic options are also highlighted briefly.
    07/2014; 1(2). DOI:10.1016/j.ijep.2014.08.001