Paediatrics: Epilepsies: neonatal

Epilepsies: neonatal

Neonatal seizures are rarely part of a benign epilepsy syndrome, expert advice should be sought.

·  They are more commonly a symptom of underlying, severe cerebral dysfunction.

·  Seizures are never generalized tonic–clonic seizures because the brain has not matured enough to produce synchronous epileptic activity.

Management

·  History: is there a family history of similar convulsions with benign prognosis? Take a history for cerebral insults such as hypoxia-ischaemia. Is there a relevant family history, including consanguinity?

·  Examination: look for neurocutaneous stigmata and dysmorphic features.

·  Blood investigations: FBC; CRP; blood glucose; serum electrolytes (calcium and phosphate).

·  Lumbar puncture: CSF glucose, red blood cell count (RCC), and white cell count (WCC); CSF microscopy and growth culture; CSF lactate and glycine; CSF latex agglutin (group B streptococci).

Epileptic encephalopathy If no cause is evident consider the investiga-tions for epileptic encephalopathy. Follow advice of the biochemist for further investigation or management of relevant results

Drug treatment

·  Phenobarbital: treat by loading with 20mg/kg IV. Continue on 5mg/kg once daily for at least 2wks.

·  Pyridoxal phosphate 10mg/kg/qds PO: if the infant is unresponsive to Phenobarbital, treat with pyridoxal phosphate. If possible wait for 48hr to assess effect.

·  Clonazepam: if the pyridoxal phosphate has proved ineffective or the seizures continue to give the child significant cardiorespiratory compromise, commence infusion of IV clonazepam at 5micrograms/ kg/min increasing as seizures continue up to a maximum of 20micrograms/kg/min.