Neonatal seizures

Seizures in neonates are common and often suggest a serious underlying brain injury such as hypoxia-ischemia, stroke, or hemorrhage. There is a lack of evidence regarding optimal monitoring, evaluation, and treatment for newborns with seizures. Prolonged video-electroencephalogram (EEG) is the gold standard for detecting seizures, whereas amplitude-integrated EEG may be a convenient and useful screening tool. Evaluation involves a thorough search for the etiology of the seizures and includes detailed clinical history, routine chemistries, neuroimaging (preferably MRI), and specialized testing such as screening for inborn error of metabolism if no structural cause is readily apparent. There is a lack of consensus regarding the relative risk versus benefit for aggressive medical treatment of neonatal seizures. Evidence is increasing that seizures themselves impair brain development, but there is evidence in animal models that commonly used medications are potentially neurotoxic. We believe that medical management with a goal of eliminating electrographic and electroclinical seizures is probably warranted.