Apneic seizures in the newborn

ArticleinAmerican journal of diseases of children (1960) 136(11):980-4 · December 1982with38 Reads
Source: PubMed
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.
    • "An infant with a temporal lobe haemorrhage often presents with apnoeic episodes, which turn out to be of epileptic origin when continuous aEEG monitoring is used (Hoogstraate et al., 2009). Epileptic apnoeic episodes are thought to originate from the limbic system (Watanabe et al., 1982). "
    [Show abstract] [Hide abstract] ABSTRACT: AimThe aim of this study was to delineate aetiologies and explore the diagnostic value of cerebral magnetic resonance imaging (MRI) in addition to cranial ultrasonography (cUS) in infants presenting with neonatal seizures.Method This retrospective cohort study comprised infants (gestational age 35.0–42.6wks) with seizures, confirmed by either continuous amplitude-integrated electroencephalography (aEEG) or standard EEG and admitted during a 14-year period to a level three neonatal intensive care unit (n=378; 216 males, 162 females; mean [SD] birthweight 3334g [594]). All infants underwent cUS and MRI (MRI on median of 5 days after birth, range 0–58d) within the first admission period.ResultsAn underlying aetiology was identified in 354 infants (93.7%). The most common aetiologies identified were hypoxic–ischaemic encephalopathy (46%), intracranial haemorrhage (12.2%), and perinatal arterial ischaemic stroke (10.6%). When comparing MRI with cUS in these 354 infants MRI showed new findings which did not become apparent on cUS, contributing to a diagnosis in 42 (11.9%) infants and providing additional information to cUS, contributing to a diagnosis in 141 (39.8%). cUS alone would have allowed a diagnosis in only 37.9% of infants (134/354).InterpretationCerebral MRI contributed to making a diagnosis in the majority of infants. In 11.9% of infants the diagnosis would have been missed if only cUS were used and cerebral MRI added significantly to the information obtained in 39.8% of infants. These data suggest that cerebral MRI should be performed in all newborn infants presenting with EEG- or aEEG-confirmed seizures.
    Full-text · Article · Nov 2014
    • "When it was possible to identify sleep stages, a significant predominance of ictal activity was found during REM sleep as compared to NREM [63]. A similar condition was also observed by Watanabe and collaborators regarding apneic seizures that seem to occur invariably during REM sleep [45]. We can conclude from the above that sleep regulation in the context of neonatal seizures is frequently abnormal, as most of them exhibit acute or subacute encephalopathies related to the associated etiology of seizures. "
    [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.
    Full-text · Article · Aug 2010
    • "Kellaway, 1987; Volpe, 2001). Eye opening has been used as one feature helping to distinguish between apnea of epileptic and nonepileptic origin (Watanabe et al., 1982) and between seizures and nonepileptic jitteriness (Volpe, 2001). Whether eyes are open during nonsubtle seizures has not so far been reported in the literature. "
    [Show abstract] [Hide abstract] ABSTRACT: It has been shown that persistent eye closure during paroxysmal events in infants makes seizures unlikely. Our study aims to assess whether this is also true in neonates. We reviewed and classified all archived neonatal seizures in our video database, considering electroclinical seizures only and excluding electrographic seizures and clinical seizures without ictal change in EEG. We assessed whether eyes were open during the seizure. One hundred and thirty-one electroclinical seizures (clonic, focal and generalized tonic, tonic-clonic, generalized myoclonic, subtle and spasms) in 46 neonates were included. In 115 (88%) seizures, eyes were open; in 10 seizures, they were closed; and in six seizures, eye opening could not be evaluated. All 10 seizures with persistent eye closure were clonic seizures. Our data demonstrate that persistent eye closure during an event suggestive of a seizure in a newborn makes an electroclinical seizure unlikely.
    Article · Mar 2007
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