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Neonatal Seizures

Definitions and Epidemiology

A seizure is a sudden, paroxysmal discharge of a population of neurons that causes a transient alteration in neurologic function. This alteration may involve abnormal motor activity, sensory symptoms, a change in the level of alertness, alteration in autonomic function, or any combination of these. When a seizure occurs in the neonatal period, several special considerations arise (Table 1). A seizure in a newborn almost always reflects significant nervous system pathology, and recognizing and treating seizures properly may prevent subsequent chronic neurologic impairment. It is important not to confuse seizures with epilepsy. A seizure is a single event and may be due to a transient abnormality that will not recur (eg, hypoglycemia). Epilepsy is the condition of unprovoked recurrent seizures. Many neonatal seizures are transient events that will not progress to epilepsy. Ictal refers to clinical (based on visual observation) or electrical (based on the electroencephalogram [EEG]) activity occurring during a seizure (Table 2).

Seizures occur in about 0.2% to 1.4% of all newborns. However, the incidence is much higher among certain high-risk groups. About 20% of newborns whose birthweight is less than 2500 g have seizures, with a higher incidence among sicker preterm infants. Incidence also depends on etiology; as many as 50% of newborns who have severe hypoxic-ischemic encephalopathy (HIE) develop neonatal seizures.

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