Seizures and Status Epilepticus

               Don Olson

DIAGNOSIS/INDICATION

History

1. Seizure-predisposing conditions in the neonate are, for example,

    Asphyxia

    Prolonged low Apgar scores/resuscitation

    Birth trauma

    Sepsis or central nervous system (CNS) infection

2. Maternal factors

    Diabetes (hypoglycemic infant)

    Fever/chorioamnionitis (sepsis)

    Viral infection (eg, herpes)

    Group B streptococcus carriage

3. Pharmacologically restrained and sedated neonates with “at-risk” conditions

4. Family history of siblings or parents with recognized or suspected genetic conditions predisposing to seizures (eg, benign familial neonatal seizure [BFNS], tuberous sclerosis)

Physical

1. Dysmorphic features or multiple congenital anomalies (suggesting possible cerebral malformation)

2. Seizures most commonly occur as repeated, stereotyped episodes of

    Focal clonic limb jerking

    Tonic limb posturing with or without head and eye deviation

    Subtle phenomena, such as stereotyped chewing, tongue thrusting, bicycling, or swimming movements

    Vital sign changes (eg, apnea, tachycardia, hypo- or hypertension)

Confirmatory/Baseline Tests

1. Initial blood tests

    Glucose

    Electrolytes

    Calcium/magnesium

    Culture

    Complete blood cell count and differential

2. Urine analysis and culture

3. Cerebrospinal fluid

    Cell count and differential

    Glucose (simultaneous serum glucose recommended) and protein

    Bacterial and viral cultures

    Herpes polymerase chain reaction (PCR)

4. Electroencephalogram (EEG) to look for evidence of frequent or continuous seizures, correlate suspicious movements with ictal EEG rhythm, features suggesting focal cortical dysfunction or underlying inborn error of metabolism

5. Neuroimaging

    Ultrasound (intraparenchymal hemorrhage, malformation with ventriculomegaly)

    Computerized tomography (intraparenchymal and superficial hemorrhage, cerebral malformation, intraparenchymal calcification [congenital infection])

    Magnetic resonance imaging (MRI) (cerebral malformation, stroke, hemorrhage, sinovenous thrombosis, vascular malformation)

Further Tests

1. Further blood tests

    Amino acids

    Arterial lactate, pyruvate, and ammonia levels

Stay updated, free articles. Join our Telegram channel

Join