Seizure Disorder or Epilepsy or Convulsion
Convulsion are series of forceful involuntary contraction and relaxation of voluntary muscle due to disturbance of brain function.
Convulsion are abnormal, involuntary, Paroxysmal, Motor/sensory, Autonomic/ Senorial changes resulting from abnormal electrical discharge from brain.
Etiology of Seizures
1. Early neonatal period
Birth asphyxia
Intraventricular hemorrhage
Hypoglycemia
Hypocalcaemia
Hyponatremia
Inborn error of metabolism
Pyridoxine (B6) dependency
2. Late neonatal period
Hypocalcaemia
Hypomagnesemia
Hypoglycemia
Kernicterus (excess bilirubin damaging brain)
Meningitis
Intrauterine infection
Tetanus neonatorum
Dehydration
Alkalosis
Drug
Heat stroke
3. From 1 months to 3 years
Abrupt rise in temperature (febrile Convulsion)
Infection in CNS
Post vaccination encephalopathy
Brain lesions
Pathophysiology of Seizures
Normal functioning of Na+, K+, Ca+ transport across neurones
Due to etiological factor (Hypoglycemia, bacterial toxins)
Disturbed balanced between excitatory neurotransmitter (glutamate, aspartate) and inhibitory neurotransmitters (GABA- Gama amino butyric), pyridoxine dependency at synaptic level.
Result in seizure active
Types of Neonatal Seizure
1. Subtle seizure
2. Clonic seizure
3. Tonic seizure
4. Myoclonic seizure
1. Subtle seizures
Specially seen in preterm and term baby.
Usually mild alternation in motor, behaviour or autonomic function that are not clearly clonic, tonic, or myoclonic.
2. Tonic
May be focal or generalization
Primarily preterm
Flexion or extension of muscle group
Decerebrate- tonic extension of all limb.
Decorticate- flexion of upper limb and extension of lower limb.
3. Clonic phase
May be focal or multifocal
Rhythmic movement muscle group, jerky movements
1-3 jerk per second
4. Myoclonic
May be focal, multifocal, or general
Single or multiple fast jerk of upper and lower limb.
Rigidity of muscle/ speed fast jerk movement.
Usually distinguished from clonic movement because more rapid speed of myoclonic jerk.
Non- epileptic movement
Jitteriness or tremors
Normal movement seen more commonly in preterm infants.
Causes of Neonatal Seizures
1. Developmental defects
2. Hypoxic-ischemic encephalopathy (HIF)
3. Intracranial hemorrhage
4. Infection
Diagnostic evaluation
1. Seizure history
2. Antenatal history
3. Perinatal history
4. Feeding history
5. Family history
Mandatory investigation
1. Blood sugar
2. Bilirubin; if jaundice present clinically
3. Serum electrolyte
4. Arterial blood gas (ABG), Anion gap
5. CSF examination
6. Electroencephalography (EEG)
7. Lumbar puncture
Specific investigation
CT/ MRI scan
Screening for congenital infection
1. Metabolic screening
2. Blood and urine ketones
3. Blood ammonia
4. Serum and CSF lactate
Management
1. Initial medical treatment
1. Thermoneutral environment
2. Ensure airway, breathing, circulation
3. O2 inhalation
4. IV access and fluid administration
5. Blood test for sugar
6. Neonate history
7. Clinical examination
2. Hypoglycemia - 10% dextrose given as bolus injection
3. Hypocalcaemia - After treatment hypocalcaemia give 2ml/kg of 10% calcium gluconate IV over 10 minutes under strict cardiac monitoring.
4. Anti-epileptic drug therapy (AED)
Phenytoin
Valporic acid
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