Neonatal Seizures

Neonatal Non-metabolic Seizure Distribution in Relation to Biochemical Abnormalities

Introduction Neonatal seizures are a significant neurological manifestation in the early days of life. They can cause long-term developmental disabilities and increase mortality rates if not properly managed. They can also be a sign of underlying neurological disorders, metabolic disturbances, or hypoxic-ischemic injury. Among the numerous etiologies, birth asphyxia, neonatal meningitis, and biochemical abnormalities are widespread. Biochemical abnormalities occur either as an underlying cause or as an associated abnormality. So biochemical anomalies should be excluded in every case of neonatal seizure, despite the presence of other causes of neonatal seizures. Early recognition and treatment of these biochemical disturbances are essential for optimal management and satisfactory outcomes. We assessed the proportion of newborn seizures caused by different etiologies in the current study with due emphasis on biochemical causes. Methods A prospective observational study was conducted in a university-affiliated teaching hospital between November 2015 and April 2017 (17 months). The study recruited 100 neonates who had a history of seizures. A comprehensive history and examination have been recorded upon admission, along with appropriate investigations. The study was approved by the institutional ethics committee, and all participants provided their voluntary informed consent. Results Among 100 cases of neonatal seizures, biochemical abnormalities were identified in 75 cases, comprising 52 (69.3%) non-metabolic seizures and 23 (30.6%) pure metabolic convulsions. The predominant biochemical abnormalities in neonatal seizures are hypoglycemia in 34 of 75 cases (45.3%) and hypocalcemia in 17 of 75 cases (22.7%). The most frequent abnormality in non-metabolic seizure patients was low blood sugar in 23 (44.2%), followed by low calcium in 12 (23.1%), low phosphate in eight (15.4%), high sodium in six (11.5%), low sodium in two (3.8%), and low magnesium in one (1.9%). Out of the 23 subjects with hypoglycemia in non-metabolic seizures, 12 (52.1%) were associated with perinatal asphyxia, while 11 (47.9%) were linked to septicemia. The biochemical abnormalities identified in metabolic seizures were hypophosphatemia in four (17.4%), hypomagnesemia in three (13%), hypoglycemia in 11 of 23 patients (47.8%), and hypocalcemia in five (21.7%). Conclusion Improving outcomes and quality of life for newborns impacted by non-metabolic neonatal seizures requires a comprehensive approach to treatment. This includes the appropriate therapy, the results of the biochemical testing, and the clinical evaluation.