Lec 8 convulsion written .pdf hjngfhhhbft

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1. Neonatal Convulsion

2. Convulsion : Paroxysmal alteration in the neurological functions.
Motor ( most common)
Autonomic: vital signs (BP , HR ) ..

3. Seizures in neonates are usually not generalized (due to immature axonal sheath).
•Fit in neonates is different from that in infants & older children, it's called subtlefit si dna
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a. Focal motor fit involving one group of muscles.
b. Abnormal movements including :
▪Eye rolling.
▪Lip smacking .
▪Frothing .
▪Bicycling movements in the lower limbs. .attacks of cyanosis
•Hypoxic fit develops mostly in the first 72hours of life.
and is
Characterized by :
, Excessive blinking or sustained opening of the eyes
, Tongue protrusion , chewing, sucking
, attack of apnea
Central

4. Other form:
1-Focal clonic seizures
2-Multifocal clonic seizures.
3-Tonic seizures
4-Myoclonic seizures.
Clonic : contraction of flexors and extensors which is repetitive and rhythmic
Sustained contraction (severe form) either focal or generalized
Jerky movement, non repetitive and non rhythmic
Focal seizures are more serious than generalized because Focal seizures occur mostly due to structural
pathology in the brain (stroke,infarction,hemorrhage) while generalized seizures occur mostly due metabolic
disorders such electrolyte disturbances, hypoglycemia and these are correctable causes

5. Causes
a. CNS congenital malformations .
b. Hypoxic ischemic encephalopathy (caused by birth asphyxia most common cause in first
72hr) .
c. Intracranial hemorrhage (caused by birth difficulties or prematurity) .
●Preterm newborns have an increased risk of intra-ventricular hemorrhage (IVH). (due to
fragility of blood vessels)
●Signs of intracranial hemorrhage :
1 .Fits .
2 .Bulging fontanelle .
3 .Decreasing PCV.
HIE : first 12 -24 hr up to 72 hr
PVH
4- lethargy and coma
Convulsions caused by HIE are refractory to usual doses of AC

6. d. Electrolyte disturbance: Hypernatremia, Hyponatremia, hypocalcemia,
hypomagnesemia
e. pyridoxine dependency(refractory to treatment)
f. amino acide disorder
g. infection (sepsis-meningitis)
h. Kernicterus
i. drug withdrawal
j. hypoglycemia (first thing that should be excluded In patient)
-Note: hypo or hyperkalemia don't cross BBB so not cause fit
K : No effect on the brain
Na : No effect on the heart
B6
Most common causes of neonatal convulsions:
1- hypoglycemia
2- neonatal sepsis
3- electrolytes imbalance
4- birth asphyxia
5- Kernicterus

7. Apnea of prematurity and Fit:
●Since both can produce apnea and cyanosis, you must differentiate between them by measuring
the heart rate
●Fits are associated with tachycardia .
●Apnea of prematurity is associated with bradycardia.
Subtle
Also cyanosis the same

8. Q/ jitteriness vs convulsion?
Jitteriness: is a tremor that exacerbated by stimulation & decreased with quietness, it is
characteristic of:
●Hypoglycemia.
●Hypocalcemia.
Maybe normal finding

9. Jitteriness : Disappear by holding the limb
Some conditions are difficult to be distinguished and may require EEG

10. Diagnosis
-History-Physical examinations: general &neurological exam. (neonatal reflex)
-Lab. Tests: serum chemistry (RBS, PCV, electrolytes), CSF, blo. ammonia, A.A
measurement.
-Radiological examinations, U\s of the brain. (CNS anomaly-calcification (TORCH), ICH
-EEG.
PCV :
Increased = polycythemia = thrombosis = cerebral ischemia = convulsion
Decreased = ICH
TSB Sepsis
CMV
HIV
Toxoplasmosis
CT , MRI
-ve EEG does NOT exclude convulsion

11. Treatment
1 )ABC including oxygen.
2 )Anticonvulsants agents: Phenobarbital (DOC in neonate), phynition, diazepam ,
lorazepam, paraldehyde.
3 )Rx of the underlying cause is essential.
Lt lateral position to prevent aspiration pneumonia
Loading: 20 mg/kg, maintenance : 5 mg/kg 0.1 - 0.3 mg/kg
If no response = GA
1-Diazepam (very rapid action) :
* iv: slowly 0.1 - 0.3 mg/kg
* rectally : through NG tube 0.5 - 1 mg/kg then flushing with NS
3 times every 15 min only

2-Phenobarbital (Luminal) :
*iv : bolus(loading) dose = 20 mg/kg
Maintenance dose = 5 mg/kg

3-Phenytoin : same as Luminal

4-Midazolam : iv,nasal,gel

12. Prognosis:
It depends on the cause, cong. anomaly, birth asphyxia associated with poor prognosis.

13. 6m - 6 years

14. Thank you