Characterization and classification of neonatal seizures

To characterize and classify neonatal seizures, we studied 349 neonates, using a portable, cribside EEG/ polygraphic/video monitoring system. We recorded 415 clinical seizures in 71 infants; 11 other infants had electrical seizure activity without clinical accompaniments. Each seizure was analyzed in terms of its clinical character and its relationship to the presence of EEG seizure activity. Focal clonic seizures, some forms of myoclonic seizures, and focal tonic seizures were consistently associated with electrical seizure activity. Most “subtle” seizures, all generalized tonic seizures, and some forms of myoclonic seizures were either not associated with EEG seizure activity or had an inconsistent relationship with such activity. Seizures that were consistently and coherently related to focal EEG seizure activity had a high correlation with focal brain lesions and a favorable short-term outcome. Seizures with no relationship or an inconsistent relationship to EEG seizure activity were correlated with diffuse processes such as hypoxic-ischemic encephalopathy and a poor short-term outcome. The clinical and background EEG features of infants whose seizures were not accompanied by EEG seizure activity suggest that these seizures may not be epileptic in character.

[1]  Eizo Nakada,et al.  Neonatal neurology , 1984, Brain and Development.

[2]  M. Painter.  General principles of treatment: status epilepticus in neonates. , 1983, Advances in neurology.

[3]  A V Escueta,et al.  Lapse of consciousness and automatisms in temporal lobe epilepsy , 1977, Neurology.

[4]  E. Walker.  Reflex Activity of the Spinal Cord , 1934, The Yale Journal of Biology and Medicine.

[5]  M. Warner,et al.  Total absence of the cerebral hemispheres , 1951 .

[6]  R. Schain,et al.  Phenobarbital-induced brain growth retardation in artificially reared rat pups. , 1977, Biology of the neonate.

[7]  P. Morselli,et al.  Antiepileptic drug therapy in pediatrics , 1983 .

[8]  M. Levinsohn,et al.  Brainstem seizures in hydranencephaly , 1974, Neurology.

[9]  B. Graubard,et al.  Differential toxicity of chronic exposure to phenytoin, phenobarbital, or carbamazepine in cerebral cortical cell cultures. , 1985, Pediatric neurology.

[10]  Peter Kellaway,et al.  Quantitative Analysis and Characterization of Infantile Spasms , 1978, Epilepsia.

[11]  M. Steriade,et al.  Electro-clinical features of convulsions induced by stimulation of brain stem. , 1958, Journal of neurophysiology.

[12]  F. Dreifuss,et al.  Simultaneous recording of absence seizures with video tape and electroencephalography. A study of 374 seizures in 48 patients. , 1975, Brain : a journal of neurology.

[13]  J. Baglivo,et al.  Neonatal intracranial hemorrhage and phenobarbital. , 1986, Pediatrics.

[14]  F. Dreifuss,et al.  Automatisms associated with the absence of petit mal epilepsy. , 1969, Archives of neurology.

[15]  W. B. Hamby,et al.  HYDRANENCEPHALY: CLINICAL DIAGNOSIS , 1950, Pediatrics.

[16]  A. Delgado-Escueta,et al.  Proglonged epileptic twilight states: continuous recordings with nasopharyngeal electrodes and videotape analysis. , 1978, Neurology.

[17]  D. Lindsley,et al.  An electromyographic study of spasticity. , 1949, Journal of neurophysiology.

[18]  R P Hirsch,et al.  Outcome in neonates with convulsions treated in an intensive care unit , 1983, Annals of neurology.

[19]  J D Frost,et al.  Monitoring at the Baylor College of Medicine, Houston. , 1985, Electroencephalography and clinical neurophysiology. Supplement.

[20]  G. Bergey,et al.  Adverse effects of phenobarbital on morphological and biochemical development of fetal mouse spinal cord neurons in culture , 1981, Annals of neurology.

[21]  J D Frost,et al.  Precise characterization and quantification of infantile spasms , 1979, Annals of neurology.

[22]  Eli M. Mizrahi,et al.  Neonatal Electroencephalography: Clinical Features of the Newborn, Techniques of Recording, and Characteristics of the Normal EEG , 1986 .

[23]  R. Gumnit.  Behavior disorders related to epilepsy. , 1985, Electroencephalography and clinical neurophysiology. Supplement.

[24]  B. Meldrum.  Metabolic factors during prolonged seizures and their relation to nerve cell death. , 1983, Advances in neurology.

[25]  P. Gloor,et al.  Differential sensitivity of various brain structures to the epileptogenic action of penicillin , 1966 .

[26]  F. Plum,et al.  Vulnerability of developing rat brain to electroconvulsive seizures. , 1973, Archives of neurology.

[27]  P. Kellaway,et al.  Status epilepticus in newborns: a perspective on neonatal seizures. , 1983, Advances in neurology.

[28]  C. Wasterlain.  Does anoxemia play a role in the effects of neonatal seizures on brain growth? An experimental study in the rat. , 1979, European neurology.

[29]  D. Spencer,et al.  Complex partial seizures of frontal lobe origin , 1985, Annals of neurology.

[30]  C. Wasterlain,et al.  Breakdown of brain polysomes in status epilepticus. , 1972, Brain research.

[31]  R. Schain,et al.  Phenobarbital: Effects of Long-Term Administration on Behavior and Brain of Artificially Reared Rats , 1978, Science.

[32]  C. Bauer,et al.  Use of barbiturate therapy in severe perinatal asphyxia: a randomized controlled trial. , 1986, The Journal of pediatrics.