Neonatal seizures: stepping outside the comfort zone

Questions and Controversies in Neonatal Seizures

Neonatal seizures are relatively common, but their diagnosis and management remain challenging. We reviewed the scientific literature on neonatal seizures from July 1973 to November 2023. Several parameters were considered, including pathophysiology, diagnostic criteria, electroencephalographic findings and treatment. Recent classification system of seizures and epilepsies in the newborn, as well as treatment recommendations of neonatal seizures, have been proposed. Nonetheless, the approach to neonatal seizures varies among clinicians and centres, including detection, investigation, treatment and follow-up of patients. There are still many issues on the diagnosis and treatment of neonatal seizures, including the meaning or relevance of some electroencephalographic findings, the precise estimation of the seizure burden, the limited efficacy and side effects risk of antiseizure medications, and the best measures to establish the outcome.

Clinical and electroencephalography characteristics of 45 patients with neonatal seizures

OBJECTIVES

The aim of our study was to retrospectively research the semiology of neonatal seizures (NSs) based on the 2021 classification scheme of the International League Against Epilepsy, and the relationship between etiology and electroclinical features.

METHODS

Patients admitted to Children's Hospital of Chongqing Medical University from May 1, 2020 to March 30, 2022 and diagnosed with NSs were included to retrospectively investigate the etiology, seizure characteristics, prognosis, and ictal and interictal video electroencephalography (EEG) characteristics.

RESULTS

Of the 45 patients, 73.3% had definite etiology. Twenty-seven patients had electro-clinical seizures, of which two had both electro-clinical and electrographic-only seizures. Electrographic-only seizures were reported in 18 patients. The tonic, clonic, and electrographic-only seizures were associated with various etiologies. Both tonic and clonic seizures occurred in acute symptomatic seizures and were associated with neonatal epilepsy. 50% of tonic seizures were related to genetic factors. Among the clonic seizures, 50.0% occurred in acute symptomatic seizures. Epileptic spasms always indicated neonatal epilepsy. There were few patients who experienced automatisms and sequential seizures, and these two seizure types were associated with brain malformation and genetic factors, respectively. Patients with a normal interictal EEG had acute symptomatic seizures. whereas the interictal EEG of patients with neonatal epilepsy mainly showed burst-suppression or multifocal discharges. The ictal EEG recordings were related to seizure semiology.

CONCLUSION

Seizure semiology and video EEG are suggestive of potential causes but do not provide a definite etiology.