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SEIZURES
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INTRODUCTION
Paroxysmal alteration in neonatal behavior and (or)
motor,
autonomic
function
initiated
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by
in newborn period
Common problem in the neonatal ICU that
evokes urgent reaction
Therefore, it is critical to
RECOGINZE neonatal seizures
DETERMINE ETIOLOGY
TREAT
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CORRELATION OF TIME OF
ONSET OF SEIZURES AND
AETIOLOGY
Most Frequent Time Aetiology of Seizures
Hypoxic - ischaemic encephalopathy
< 48 Hrs.
Intra cranial haemorrhage
Hypoglycemia, Hypoelectrolytemia
Congenital Viral infections
Drug induced
Pyridoxine dependency
Non-ketotic Hyperglycemia
Urea cycle disorder
48-72 Hrs.
7 days
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CLINICAL FEATURES
SUBTLE SEIZURES
Eyes
Oral
Apnea
Motor
Autonomic
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JITTERINESS
SEIZURES
Tremor
Clonic
Jerking
8
:
Usually associated with neuropathology
(i.e. Cerebral infarction and intra cerebral haemorrhage)
Multi focal :
:
:
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Tonic Seizures
Focal
:
Sustained posturing of a limb or asymmetric
posturing of the trunk and / or neck
Generalised
:Decerebrate posturing
Decorticate posturing
Usually associated with apnoea and
upward gaze of eyes
Most common in preemies and usually
indicates structural brain damage and IVH
IV Myoclonic seizures
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:Asynchronous twitching of
several parts of body.
:Bilateral jerks of upper and some times
lower limps
:Rapid movements of distal flexors
All 3
types
of may occur during sleep in the new born.
:Characterised brief repeated extension
and
flexion movements of the arms, legs or all
limbs.
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INVESTIGATIONS
- Complete Hemogram
- Blood
C/s.
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- EEG
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GENERAL MEASURES :
OPTIMISE
:
Ventilation, Circulation,
Electrolytes,
Acid-Base Balance
NONEPILEPTIC
EVENTS :
Associated with No EEG
Seizure
Activity. These
Types of Neonatal
Seizures Should not be Treated.
EPILEPTIC
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EVENTS :
Associated with EEG Seizure
MANAGEMENT Contd..
SPECIFIC MEASURES
IF HYPOGLYCEMIA IS PRESENT
If There Is No Seizures
Stop Further Management
Monitor Vital Signs
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MANAGEMENT Contd..
If the Convulsions Persist
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MANAGEMENT Contd..
If there is further convulsion repeat inj. Phenobarbitone
10mg/kg by I.V. as third Dose (Cumulative dose of 40
mg/kg) consider omission of this additional
phenobarbitol if the infant is severely Asphyxiated.
+
Administer Inj. Phenytoin sodium concomitantly 15-20
Mg/kg diluted in Normal Saline (1mg/kg/mt) followed
by Maintenance Dose of Inj. Phenytoin &
Phenobarbitone Alternatively
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MANAGEMENT Contd..
(or)
Inj. Clonzepam Loading dose of 0.25 mg/kg
followed by 0.01 to 0.03 mg/kg/orally given
(or)
Inj. Midazolam 0.02 to 0.1 mg/kg - I.V. can be
given
DIAZEPAM : Not safe in neonates as it interferes
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MANAGEMENT Contd..
I.V. DIAZEPAM
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MANAGEMENT Contd..
OTHER MEDICATIONS
Calcium : 10% Cal. Gluconate 2 ml/kg mixed
50%
magnesium
sulphate
administered by IM route.
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0.2
ml/kg
Pyridoxine 100 mg iv
Caution: May cause severe hypotonia, bradycardia,
apnea
Treat with daily B6, 200 mg/ day
B6 withdrawal challenge to confirm dx
Seizure recur in 7 days to 3 weeks
Restart B6
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Mildly abnormal
Better
Moderately Abnormal
Worse
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DURATION OF ANTICONVULSANT
THERAPY GUIDELINES
NEONATAL PERIOD
- If neonatal Neurologic examination becomes normal,
discontinue therapy.
- If Neonatal Neurologic examination is persistently
abnormal, consider etiology & obtain EEG.
- In most such cases.
- Continue Phenobarbital
- Discontinue phenytoin
- Re-evaluate in 1 month.
has
become
normal,
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seizures
Hypoxic ischemic brain injury
Cortical dysgenesis
Hypocalcemia, late
30%
100%
0%
neonatal EEG
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CONCLUSION
Neonates with seizures require unique
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Thank you
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