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 benignprognosis? Take a history for cerebral insults such as hypoxia-ischaemia. Is there a relevant family history, including consanguinity?
• Examination: look for neurocutaneous stigmata and dysmorphicfeatures.
• Blood investigations: FBC; CRP; blood glucose; serum electrolytes(calcium and phosphate).
• Lumbar puncture: CSF glucose, red blood cell count (RCC), and whitecell 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 investigations 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/kgonce daily for at least 2wks.
• Pyridoxal phosphate 10mg/kg/qds PO: if the infant is unresponsive toPhenobarbital, treat with pyridoxal phosphate. If possible wait for 48hr to assess effect.
• Clonazepam: if the pyridoxal phosphate has proved ineffective orthe 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.