Neonatal seizure
Overview:
- Introduction
- Epidemiology
- Definition
- Pathophysiology
- Probable mechanism
- Etiology
- Differential diagnosis
- History taking
- Investigation
- management
Introduction:
- Most common neurological condition
- Neonates are high risk than other age group
- The increase risk of seizure in neonates are multi factorial they are.
- High frequency of brain injury due to
- Global hypoxia-ischemia
- Metabolic abnormalities
- Stroke& ICH
Epidemiology:
- Depends on birth weight & gestation 10.3 per live births, preterm infants had more than twice the incidence when compared to them neonates.
Definition:
- Seizure is the paroxysmal alternation in neurological function behavioral ,motor & autonomic.
- These occur during first 28 days, mostly occur shortly after birth.
- Because of cerebral cortex is immature, seizure in neonates can be extremely subtle consisting of
- Lip smacking
- Eye deviation or apnea
- Motor activity is normal
Pathophysiology:
- Neonatal seizure activities results from an excessive synchronous electrical discharge (depolarization)of neuron within CNS The process of depolarization occurs by the inward migration of (Na*)& repolarization by the efflux of (K*)
- A potential is maintained across the membrane due to ionic movements it requires energy (ATP or ATP dependent pump) which extrudes Na* from cells & sucks in K*
Probable mechanism:
- Failure of Na*-K* pump secondary to reduce energy production
- Excess of excitatory neurotransmitter R
- Relative deficiency of inhibitory neurotransmitter
- Membrane alteration with increased Na* influx
Causes of neonatal seizure:
Perinal events:
- Hypoxic ischemic encephalopathy (HIE)
- ICH
- Hypoglycemia: pre term, low birth weight infant of diabetic mother
- Hypocalcemia
- Hypomagnesaemia
- Hypo&hyper natremia
- bacterial
- meningitis
- cerebral cortical dysgenesis
- Neuronal migration disorder
Miscellaneous:
- Drug withdrawal
- Drug toxicity
- Polycythemia
- Hypertensive encephalopathy
- Accidental injection of LA into fetal scalp
neonatal seizure symptoms:
Symptoms of Subtle seizures:
- Random or roving eye movements,
- eyelied blinking or fluttering,
- eyes rolling up,
- Sucking smacking, chewing and protruding tongue
- Unusual cycling or struggling movements
- Long pauses in breathing(apnea)
symptoms of Clonic seizure:
- Rhythmic jerking movements –that may involve the muscle of the face, tongue, arms, legs or other region of the body
Symptoms of tonic seizure:
Stiffening or tightening of the muscles
Turning of the head or eyes to one side, or bending or stretching one or more arms or legs
Symptoms of myoclonic seizure:
Quick, single jerking motions, involving one arm or leg or the whole body
History taking in Neonatal seizure:
- detail of delivery,
- Apgar score @ birth Birth weight
- Gestational age
- Breastfeeding or not
- Maternal drug history
- Family history of seizures
- Withdrawal of narcotic drug
Investigation:
Blood testing:
- Blood glucose
- Calcium Magnesium Electrolytes
- Lactate
- pH
- Complete blood count
Urine testing:
- Urinalysis
- Toxicology screen Reducing substances ,
- organic acids
- cells Protein & glucose Cultures
- Herpes virus polymerase chain reaction assay
- Lactate
- Amino acids
NeuroImaging:
- Head ultrasound examination
- Head computed tomography(CT) Brain
- magnetic resonance imaging(MRI)
- EEG(electroencephalogram)
- EEG is used to find problem related to electrical activity of the brain.
Treatment:
Neonates with seizure
2Ensure the patient Airway, Breathing, Circulation.
3. Ventilator support should be available
4. Secure IV access and do blood sugar test and and collect blood for baseline investigation
5.If blood sugar is less than 40mg/dl , administered 2ml/kg of 10% dextrose as bolus as followed by continuous infusion of 6-8mg/kg/min.
Seizure continue do :
1. Administer phenobarbital 20mg/kg, IV over 10-15min.
Seizure continued:
1.additional dose of phenobarbital 5mg/kg every 5mins still convulsions stop or total dose of 40mg/kg is reached
(Exception: severe birth asphyxia patient don't give over additional dose of loading dose 20mg/kg )
Seizure continued;
administer phenytoin 20mg/kg over IV,
fosphenytoin is preferred drug (1.5mg fosphenytoin yield 1mg phenytoin).
Seizure continued:
Administer lorazepam 0.05-010mg/kg IV over 2-5min.
Seizure continued:
Administer midazolam 0.2 mg IV bolus then 0.1-0.4mg/kg /hr consider other antiepileptic Drug (AED).
Seizure stopped:
Wean the antiepileptic drug slowly to maintain phenobarbital 3-5 mg/kg/day.
In two dose started 12hrs after the loading dose
.
This website for medical students who struggle to study over the books this for yours we are given as a consiced format more...
No comments:
Post a Comment