Therapy of neonatal seizures
Michael J. Painter, MD
Division of Child Neurology, 3705 5th Avenue, Pittsburgh, Pennsylvania, 15213
DIAGNOSIS AND TREATMENT OF UNDERLYING CAUSES
LIKE all therapies, the treatment of neonatal seizures is dependent on proper diagnosis. Thus, it is essential to determine if the seizures are of metabolic, toxic, or structural origin, since treatment of each of these disorders is quite different. Diagnosis of the etiology of neonatal seizures begins with a proper history (Figure 1).
Frequently the infant's mother is remote from the neonatal intensive care unit; and if the child is out-born, family members are not easily accessible. Hence, there is frequently a delay in obtaining a family history, and details regarding the labor and delivery period are often missing. It is important to obtain a maternal drug history, details suggestive of infections during pregnancy as well as those surrounding the labor and delivery process, and a family history of neonatal seizures or deaths. Although hypoxic ischemic encephalopathy is currently regarded as the most common cause of neonatal seizures, without a proper history many entities masquerading as perinatal asphyxia are missed.
A physical examination frequently furnishes clues to the etiology of the seizure state. Blood pressure should not be overlooked, as hypertensive encephalopathy may cause seizures in neonates.1 Treatment of this disorder employs agents to control blood pressure rather than standard anticonvulsive drugs. Skin lesions are a clue to both infection and neurocutaneous syndromes. Visualization of the retina is frequently difficult with a standard ophthalmoscope, but indirect funduscopy should be performed by a qualified professional, since retinal hemorrhages are indicative of trauma and chorioretinitis suggestive. . .