Clinical and neurophysiologic correlates of neonatal seizures

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SEIZURES pose a number of problems in the care of newborn infants. Seizure hazard is greater in the neonatal period than at any other time. In addition, clinical seizures are the most frequent sign—and indeed may be the only sign—of central nervous system (CNS) disorder in the neonate. Clinical seizures, however, may be difficult to recognize, and if untreated, may further compromise an already injured developing brain. Conventional anticonvulsant therapy, on the other hand, may not be completely effective in eliminating seizures, and over-treatment with large doses of anticonvulsants may also have adverse effects on the immature brain.

To address these problems of diagnosis and management effectively, it is essential that clinical seizures be recognized and distinguished from other behaviors that are not seizures. In clinical practice, however, most abnormal, stereotypic behaviors of the neonate are considered to be seizures and presumed to be epileptic in origin. Utilizing cribside electroencephalographic (EEG)/polygraphic/video monitoring, we have recently evaluated this concept and the assumption that all neonatal seizures are initiated and mediated by the same pathophysiological mechanism.1


The clinical features of neonatal seizures have been characterized by others over the past several years. Most notable are several French investigators2–6 who, beginning in the 1950s, described almost all the clinical manifestations currently considered to be seizures. Motor phenomena were characterized as either generalized tonic or focal or multifocal clonic. Clonic seizures could be bilateral but occur asynchronously on two sides of the body. It was appreciated. . .



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