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Neonatal seizure: what is the cause?

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6003 (Published 12 September 2012) Cite this as: BMJ 2012;345:e6003
  1. Manish Prasad, paediatric neurology grid registrar,
  2. Gabriel Chow, consultant paediatric neurologist
  1. 1Queens Medical Centre, Nottingham University Children’s Hospital, Nottingham NG7 2UH, UK
  1. Correspondence to: M Prasad m.prasad{at}nhs.net

A 7 day old girl presented with a one day history of decreased feeding, lethargy, and shaking of her extremities. She was born at term by normal vaginal delivery. She did not have a fever and there were no maternal risk factors for sepsis. She was hypotonic and minimally responsive on examination, with no signs of focal neurology.

Urea, electrolytes, calcium, and glucose values were normal. She was started empirically on intravenous antibiotics and aciclovir after full septic screen. She was ventilated and given an infusion of midazolam because her generalised clonic seizures with apnoea failed to respond to intravenous phenobarbital. Her seizures finally responded and she was extubated after 24 hours; she was maintained on regular phenobarbital with good effect.

Urgent neuroimaging (figs 1 and 2) was arranged because of her acute presentation with seizures and a history of deep vein thrombosis and pulmonary embolism in her mother and maternal uncle.

Fig 1 Sagittal T1 weighted magnetic resonance image of the brain

Fig 2 Axial T1 weighted magnetic resonance image of the brain

Questions

  • 1 What are the causes of seizures in a neonate?

  • 2 What is the differential diagnosis of seizures in neonates?

  • 3 What are the findings on neuroimaging?

  • 4 What is the most likely diagnosis?

  • 5 How would you manage this condition in neonates?

Answers

1 What are the causes of seizures in a neonate?

Short answer

Common causes of neonatal seizures include hypoxic ischaemic encephalopathy, intracranial haemorrhage, intracranial infections, congenital cerebral malformations, metabolic disorders, and focal ischaemic stroke.

Long answer

Seizures are more common in the neonatal period than in any other time of life, with 80% occurring in the first week of life. This is because the immature …

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