Points & Pearls Excerpt
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Compared to seizures in older children, neonatal seizures can be subtle and difficult to diagnose, leading to higher mortality, worse prognosis, and long-term neurodevelopmental sequelae.
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The leading causes of neonatal seizures are hypoxic ischemic encephalopathy from birth trauma, vascular disorders, infections, and acquired metabolic derangements. Brain malformations, inherited seizure disorders, drug sequelae, and kernicterus can also lead to seizures.
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The age of the neonate at the time of seizure presentation can aid in determining etiology, as can maternal, perinatal, and feeding histories. Physical examination findings such as macrocephaly, bulging fontanelle, facial dysmorphisms, organomegaly, congenital rashes, skin lesions, and myoclonus can also aid in diagnosis.
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Seizures in neonates are most often focal, with abnormal eye movements as the most common manifestation. Focal tonic-clonic extremity movements, arm or leg pedaling movements, tongue thrusting, and lip-smacking can also be presenting signs.
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Treatable causes of seizures include derangements in glucose, sodium, calcium, magnesium, and pyridoxine. Hyponatremia should be corrected slowly to decrease risk of pontine demyelination syndrome.
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