Clinical analysis of risk factors for adverse outcomes of neonatal seizure / 中国新生儿科杂志

Objective:To study the neurodevelopmental prognosis and risk factors for adverse outcomes of neonatal seizure.Methods:From December 2019 to November 2020, infants with neonatal seizure diagnosed in our hospital were enrolled in this retrospective study. Based on survival or not, mental development index (MDI), psychomotor development index (PDI) and seizure episodes at the age of 12 months, the infants were assigned into adverse outcome group and normal outcome group. The risk factors for adverse outcomes were statistically analyzed.Results:A total of 75 infants were enrolled,including 39 cases in adverse outcome group and 36 in normal outcome group. 69 cases showed abnormal amplitude-integrated electroencephalogram(aEEG), including 38 mildly abnormal cases,23 moderately abnormal cases and 8 severely abnormal cases, The incidences of adverse outcomes and mortality rates were significantly different ( P<0.05) among infants with different severity levels of aEEG abnormalities and the severity levels of aEEG abnormalities were positively correlated with adverse outcomes ( r=0.367, 0.471, P<0.05).Univariate analysis showed that adverse outcome group had significantly higher incidences of chorioamnionitis, seizure onset age ≤3 d, 5 min Apgar score ≤3, cranial ultrasound abnormalities, brain MR abnormalities and aEEG abnormalities than normal outcome group ( P<0.05).Logistic regression analysis showed that seizure onset age ≤3 d ( OR=3.988, 95% CI 1.376-11.674), abnormal brain MR ( OR=3.296, 95% CI 2.383-17.377) and bilirubin encephalopathy ( OR=3.792,95% CI 2.110-13.216) were independent risk factors for adverse outcomes of neonatal seizure. Conclusions:For neonatal seizure, the infants with more severe abnormal aEEG will have higher incidences of adverse outcomes and mortality. Seizure onset age ≤3 d, brain MR abnormalities and bilirubin encephalopathy were independent risk factors for adverse outcomes of neonatal seizure.

Neonatal Seizures—Perspective in Low-and Middle-Income Countries

Neonatal seizures are the commonest neurological emergency and are associated with poor neurodevelopmental outcome. While they are generally difcult to diagnose and treat, they pose a signifcant clinical challenge for physicians in low- and middle-income countries (LMIC). They are mostly provoked seizures caused by an acute brain insult such as hypoxic– ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the central nervous system, or acute metabolic disturbances. Early onset epilepsy syndromes are less common. Clinical diagnosis of seizures in the neonatal period are frequently inaccurate, as clinical manifestations are difcult to distinguish from nonseizure behavior. Additionally, a high proportion of seizures are electrographic-only without any clinical manifestations, making diagnosis with EEG or aEEG a necessity. Only focal clonic and focal tonic seizures can be diagnosed clinically with adequate diagnostic certainty. Prompt diagnosis and timely treatment are important, with evidence suggesting that early treatment improves the response to antiseizure medication. The vast majority of published studies are from high-income countries, making extrapolation to LMIC impossible, thus highlighting the urgent need for a better understanding of the etiologies, comorbidities, and drug trials evaluating safety and efcacy in LMIC. In this review paper, the authors present the latest data on etiology, diagnosis, classifcation, and guidelines for the management of neonates with the emphasis on low-resource settings.

The clinical value of video-electroencephalogram on the diagnosis and prognosis of neonatal seizure / 中国新生儿科杂志

Objective To study the clinical value of video-electroencephalogram (VEEG) on the diagnosis and prognosis of neonatal seizure.Method From January 2016 to December 2017,the medical records of 118 neonates who had seizure and received VEEG in our hospital were collected.The results of VEEG and medical records were analyzed using x2 test,Fisher's exact test or rank sum test.Result Among the 118 neonates,94 cases(79.6％) had abnormal VEEG results,including 59 mildly abnormal cases,21 moderately abnormal cases,and 14 severely abnormal cases.The characteristics of mildly abnormal VEEG was delayed mature,and moderately and severely abnormal VEEG were paroxysmal abnormal activities.All of the severely abnormal VEEGs showed abnormal background activities.The incidence of abnormal background activities of severely abnormal group was higher than mildly and moderately abnormal group,the difference was significant (P＜0.001).Neonates with abnormal background activities had higher rates of epileptic seizure and delayed maturation than those with normal background,and the differences were significant (P＜0.001).Among 32 neonates with paroxysmal events,17 cases had non-epileptic events including subtle seizures,myoclonus seizures,and symmnetrical tonic seizures;15 cases had epileptic electrographic seizures and electro-clinical seizures,12 cases had focal seizures.The degree of abnormal VEEG had positive correlations with the incidences of epileptic seizures and delayed maturation (P＜0.001).Conclusion Neonates with seizure has higher rate of abnormal VEEG.Non-epileptic events presents as subtle seizures and myoclonus seizures,and epileptic seizures as focal seizures.The background activities of neonatal VEEG has important predictive value for prognosis.The worse the VEEG is,the higher the possibility of epileptic seizure and delayed maturation.

Experience and pharmacokinetics of Levetiracetam in Korean neonates with neonatal seizures / 소아과

PURPOSE: The aims of this study were to evaluate the safety and pharmacokinetics of levetiracetam (LEV) in neonates with seizures and to establish a population pharmacokinetics (PPK) model by using the software NONMEM. METHODS: A retrospective analysis of 18 neonatal patients with seizures, who were treated with LEV, including 151 serum samples, was performed. The mean loading dose was 20 mg/kg, followed by a mean maintenance dose of 29 mg/kg/day. RESULTS: Seventeen neonates (94%) had seizure cessation within 1 week and 16 (84%) remained seizure-free at 30 days under the LEV therapy. The mean serum concentration of LEV was 8.7 µg/mL. Eight samples (5%) were found above the therapeutic range. No serious adverse effects were detected. In the PPK analysis for Korean neonates, the half-life was 9.6 hours; clearance, 0.357 L/hr; and volume of distribution, 4.947 L, showing differences from those in adults. CONCLUSION: LEV is a safe and effective option for the treatment of neonatal seizures with careful therapeutic drug monitoring.

Maternal Risk Factor for Seizures in Term Neonate: A Hospital –Based Case Control Study.

Background: Assessing the maternal risk factors for seizure in first 72 hours of life in term neonate. Design: Case control study. Setting: Department of Paediatrics, Neonatology unit and Maternity ward tertiary care centre Govt. Medical College, Nagpur. Methods: A 210 cases [Term neonate with seizure within first 72 hours of life] and 210 controls [Term neonate without seizure in first 72 hours of life] were randomly selected as study subject over a period of two year. Primary exposure variables in mothers including age, parity, diabetes mellitus, hypertension, anemia, intrapartum fever, mode of delivery and prolonged second stage of labor were considered in study population. Neonates were carefully examined and observed for seizures and manage accordingly. Results: Maternal diabetes mellitus and anemia were potentially significant in their association with term neonatal seizure while maternal hypertension, intrapartum fever and prolonged second stage of labor were not significantly associated with seizure. Neonates born to diabetic mother, young maternal age, anemic mother and cesarean delivered neonate had 1.97, 0.95, 1.83 and 2.18 time more risk to developed seizure respectively. Conclusion: Early identification and timely intervention of maternal risk factor may reduces the seizure in term neonate.

Effects of ketogenic diet on neurobehavioral damages and expression of ZIP7 in cerebral cortex of rat following recurrent neonatal seizures / 中华行为医学与脑科学杂志

Objective To explore the intervention effect of ketogenic diet (KD) on neurobehavioral damages after flurothyl-induced neonatal recurrent seizures in rats and on the expression of ZIP7.Methods Postnatal day 8 SD rats (n=24) were divided into four groups randomly:normal group (NS+ND group),non-seizure and ketogenic diet group (NS+KD group),seizure and normal diet group (RS+ND group),seizure and ketogenic diet group (RS+KD group),n=6 in eacb group.At postnatal day 31,the grip-strength test and open field test were monitored.At postnatal day 32,rats were sacrificed and the expression of ZIP7 protein level in cerebral cortex was detected with Western blot.Results (1) The grip-strength test:compared with NS+ND group ((32.67±2.42) s),the time needed to hold on glass bar in RS+ND group ((19.17±2.48) s) was shorter significantly (P＜0.05).Compared with RS+ND group,the time needed to hold on glass bar in RS+KD group ((26.25±2.87) s) was significantly longer (P＜0.05).(2) Open field test:compared with NS+ ND group ((2.00± 0.63) times),the times of grooming in RS+ND group ((4.00±0.63) times) were more (P＜0.05).Compared with RS+ND group,the times of grooming in the RS+KD group ((2.17±0.75) times) were fewer (P＜0.05).(3)Western blot:compared with NS +ND group,the level of ZIP7 of the RS+ND group in cerebral cortex were lower (P＜0.05).Compared with RS+ND group,the level of ZIP7 of the RS+KD group in cerebral cortex were higher (P＜0.05).Conclusion Neonatal recurrent seizures may damage neurobehavior,and the neuroprotective effects of ketogenic diet may be associated with the increasing of ZIP7 in cerebral cortex.

The effects of epidural analgesia on maternal fever and neonatal outcomes

BACKGROUND: In low-risk women at term, epidemiologic studies have shown that fever in nulliparous parturients during labor is related to epidural use. Moreover, effects of fever associated with epidural analgesia on adverse neonatal outcomes have been debated. The purpose of this study is to evaluate the influence of epidural analgesia on intrapartum fever, neonatal outcomes in deliveries including nulliparity and multiparity. METHODS: We retrospectively investigated normal full-term spontaneous deliveries during 2012. Of 3,858 mother-infant pairs, 3,179 (82%) parturients received and 679 (18%) parturients did not receive epidural analgesia during labor. We regarded intrapartum fever greater than 37.5degrees C, and the parturients with fever were treated with intravenous propacetamol. We divided the study population according to labor epidural analgesia use and, fever and compared the incidence of fever and neonatal outcomes. RESULTS: Incidence of fever was higher in the epidural group compared with the no epidural group (21 vs. 5%). The number of babies with a 1 min Apgar < 7 was lower in the no epidural with no fever group, and neonatal seizure was more frequent in the epidural with fever group compared with the no epidural without fever group, no epidural with fever group, and the epidural without fever group. CONCLUSIONS: Incidence of fever was increased in the epidural analgesia group. Adverse neonatal outcomes were more frequent in the epidural with fever group. No conclusion whether the epidural analgesia cause neonatal adverse outcomes can be drawn due to confounding factors.

Seizure Scoring System and Neurodevelopmental Outcomes in Very Low Birth Weight Infants with Neonatal Seizures

PURPOSE: To evaluate the utility of seizure scoring system in the prediction of neurodevelopmental outcomes in very low birth weight (VLBW) infants who presented with neonatal seizures. METHODS: A retrospective review was performed in VLBW infants who were treated with antiepileptic drugs (AED) for the control of neonatal seizures. A total of 25 infants who survived and were followed-up for at least 2 years of age were included. A new seizure scoring system (the composite score 0-8) was constructed by choosing the following variables: onset, response to the AED, presence of status epilepticus, seizure types and EEG findings including background activity and epileptiform discharges. Neurodevelopmental outcomes were graded from 1 to 5 based on the developmental status and the neurologic abnormalities assessed at 18 to 24 months of postconceptional age. Risk factor analyses for predicting unfavorable outcomes (grade 3-5) versus favorable outcomes (grade 1-2) were performed. RESULTS: Compared to favorable outcome group (n=11), unfavorable outcome group (n=14) had higher incidence of subtle or generalized tonic-type seizures, the abnormal EEG background activity and poor response to AED. The composite seizure score was significantly higher in the unfavorable outcome group (3.2+/-0.7) than in the favorable outcome group (1.2+/-1.2) and it significantly correlated with the neurodevelopmental grading (P<0.001). In multivariate analysis, abnormal MRI findings at term and the composite seizure score were significant risk factors for unfavorable outcomes. CONCLUSION: In VLBW infants with neonatal seizure, the proposed seizure scoring system was a simple and useful predictor of long-term neurologic outcomes.

Effect and mechanism of ketogenic diet on neurobehavioral demages induced by recurrent neonatal seizures / 中华行为医学与脑科学杂志

Objective To investigate the intervention effect of ketogenic diet (KD) on neurobehavioral demages after flurothyl-induced recurrent neonatal seizures in rats and on the expression of ApoE.Methods Postnatal day 8 (P8) SD rats (quantity:48) were randomly divided into two groups:the non-seizure group (NS group,n =24) and the recurrent-seizure group (RS group,n =24).From P9,rats in RS group were subjected to recurrent seizures induced by volatile flurothyl 30 min each day for consecutive 8 days.While rats in NS group were placed into the container for an equal amount of time to their counterpart without exposuring to flurothyl.At P28,each group was divided into two groups again:non-seizure and normal diet group(NS + ND group,n =12),non-seizure and ketogenic diet group(NS + KD group,n =12),recurrent-seizure and normal diet group (RS + ND group,n =12),recurrent-seizure and ketogenic diet group(RS + KD group,n =12).At P42,neurodevelopmental indicators were monitored.ApoE protein levels in cerebral cortex were determined by western blot at P58.Results Neurodevelopmental indicators were analyzed at P42:in the plane righting experiment,the rats of group NS + ND (1.0 ±0.14) about the time of plane righting was significant different comparing with group RS + ND ((0.75 ±0.32) s) (P ＜ 0.05).There was no significant difference between group RS + KD and group RS + ND about the time of plane righting(P＞ 0.05).In the negative geotaxis reaction experiment,the rats of groups NS + KD and RS + ND((3.17 ± 0.58)s,(6.75 ± 0.75)s) about the time of negative geotaxis reaction were significant different comparing with group NS + ND ((1.58 ±0.52)s) (P＜0.05).Compared with group RS + ND,the group RS + KD in the time of negative geotaxis reaction was obviously shortened (P ＜ 0.05).In the cliff avoidance test,there were significant differences between group NS + ND、RS + KD ((5.75 ± 2.90) s,(9.50 ± 4.36) s) and group RS + ND ((14.00 ± 4.79) s) about the time of cliff avoidance (P ＜ 0.05).In western blot,the expression of ApoE in cerebral cortex in the RS + ND group (1.26 ± 0.30) was obviously increased compared with group NS + ND (0.78 ±0.12) (P＜0.05),and there had also significant difference between group RS + KD (0.89 ±0.10) and group RS + ND (P ＜ 0.05).Conclusion The neuroprotective effects of ketogenic diet on recurrent neonatal seizure-induced neurobehavioral demages may be associated with the reduction of ApoE in cerebral cortex.

A Case of Newborn with Prenatally Detected Cerebral Venous Sinus Thrombosis / 대한주산의학회잡지

Cerebral venous sinus thrombosis (CVST) in pediatric patients is rare, but the incidence of this disease is much higher in neonates. It is one of the important causes of neonatal seizures, and also can cause long term neurologic deficits. So far, there has been only one retrospective study of 10 neonatal CVST patients reported in Korea. However, there are no reported cases of prenatally diagnosed patient. We report a patient prenatally diagnosed with CVST which might cause severe neurologic complication, as we experienced significant decrease in size and number of thrombi without anticoagulation therapy and relatively benign clinical progress from birth to 1-year-old age.

Crisis epilépticas en la población infantil / Seizures in children

Las crisis epilépticas son un problema neurológico que afecta entre un 4-10 por ciento de los niños hasta los 16 años. Las crisis deben ser diferenciadas de otros desórdenes neurológicos de los niños y clasificadas según su tipo. El tratamiento de emergencia está focalizado en la estabilización del paciente, terminar con la actividad convulsiva y determinar la causa de ésta. Diferentes modalidades de tratamiento existen a largo plazo, pero el adecuado tratamiento va a depender de un diagnóstico correcto y el conocimiento de los beneficios y efectos adversos de la terapia indicada.

Seizures are a neurological problem that affects between 4 to 10 per cent of children up to age 16. The crisis must be differentiated from other neurological disorders of children and classified by type. Emergency treatment is focused on stabilizing the patient, ending the seizure activity and determine the cause of this. There are different treatment modalities in the long term, but proper treatment will depend on a correct diagnosis and awareness of the benefits and adverse effects of prescribed therapy.

EEG Characteristics of Full-Term Neonatal Seizures Confirmed by Electrical Seizure / 대한간질학회지

PURPOSE: Neonatal seizure is the most significant parameter of neurological insult, however its pathophysiology and diagnostic consensus is still controversial. We performed this study to investigate the characteristics of electroencephalogram (EEG) in neonatal seizures, to validate the efficacy of radiological studies, and to estimate the occurrence of further subsequent epileptic seizures. METHODS: Seventeen patients with full-term neonatal seizure confirmed by electrical seizure were enrolled. Mean birth weight is 3.29 kg, and mean duration of follow-up is 22.7 months. Medical records and EEG were retrospectively reviewed. RESULTS: Subtle seizure is the most common seizure type: subtle seizure in 6 (35%), subtle seizure with focal clonic seizure in 2(12%). In 12 patients (71%), abnormal background activities were observed, and trace discontinua is the most common abnormal finding. Ictal EEGs were mostly localized into unilateral posterior quadrant in 11 (64%), however, the remained were localized into the frontal area. Brain USG did not reveal any abnormal finding in 9 patients (53%), whereas brain MRI didn't in 4 patients (25%). Brain MRI found abnormal findings in 5 out of 9 patients with negative brain USG result. Subsequent epileptic seizures followed in 7 patients (44%). Conclusion: Background activity is still useful as an indirect marker of neonatal seizure. Different generation or propagation mechanism can be suggested in that ictal EEGs were often localized into the frontal area in minor portion. Brain MRI is more sensitive than brain USG, especially in case of cerebral infarct or hypoxic-ischemic encephalopathy.

Clinico- Biochemical Profile of Neonatal Seizure.

Objectives: The present study was undertaken to study the incidence, etiological factor, and days of onset, clinical types and biochemical abnormalities in babies having neonatal seizures. Materials and Methods: This is a retrospective, observational hospital based study. Ninety neonates, who developed seizures before 28 days of life and admitted to neonatal intensive care unit and nursery with neonatal seizure, were evaluated for incidence, etiological factor, clinical types and biochemical abnormalities found in neonatal seizure. The variables were analysed using Chi- Square and student t- test. Results: The incidence of neonatal seizure was 10.3/ 1000 live births. The seizures were common in male babies. 65 (72.2%) neonates were born to multiparous women while 35 (38%) were born to primigravidas. In birth asphyxia (n= 40), the most common type of seizure observed was subtle seizure 20 (50%), followed by focal clonic 10 (25%) and multifocal clonic 5 (12.5%). Tonic type of seizure was observed in 3 (7.5%) and myoclonic in 2 (5%). Meningitis and septicaemia was the second most common cause of neonatal seizure observed in our study. Among metabolic abnormalities hypoglycaemia was found in 20 (22%) and hypocalcaemia in 10 (11%). Conclusion: The commonest cause of seizure was birth asphyxia presenting within 72 hours of life. Among infection septicaemia and meningitis was the most common cause leading to neonatal seizure. Among biochemical abnormalities the most common cause of seizure observed in our study was hypoglycaemia and hypocalcaemia. Subtle seizures were the commonest type of seizure observed in this study.

A Scoring System to Predict the Outcomes in Neonatal Seizures / 대한소아신경학회지

PURPOSE: This study was designed to compare the follow up results with clinical and laboratory findings in patients with seizures in the neonatal period. Also, it was aimed to evaluate the usefulness of scoring prognostic factors and its efficacy as a prognostic index. METHODS: The subjects are 67 neonates who were admitted to Chungnam National University Hospital from January 1999 to April 2005 for seizures which occurred within 28 days of birth. These patients were investigated retrospectively from the hospital records. We scored clinical manifestations including gestational age, birth weight, Apgar score at 5 min, etiology, type, onset, duration, and frequency of seizures, neurologic examination results, EEG background activities, and treatment responses. Follow-up examinations were done to analyze the presence of epilepsy and neurologic deficits. A sum of the factors associated with outcomes regarded as a prognostic index, were studied. RESULTS: 50 cases(74.6%) showed normal outcomes, while 7 cases(10.4%) had unfavorable neurologic outcomes and 4 cases(6.0%) favorable neurologic outcomes with epilepsy. 6 cases(9.0%) showed unfavorable neurologic outcomes with epilepsy. All of the data including gestational age, Apgar score at 5 min, etiology, type, duration, and frequency of seizures, neurologic examination results, EEG background activities, and treatment responses were used as a prognostic index by a scoring system. When the cut-off point was 7, sensitivity, specificity, positive predictive value and negative predictive value were 76.5%, 78.0%, 54.2%, and 90.7% respectively. CONCLUSION: A scoring system for neonatal seizures earned high scores in sensitivity, specificity and negative predictive value, so that it seems to be useful as a predicitive prognostic index.

Clinical Study of Perinatal Infarcts / 대한주산의학회잡지

OBJECTIVE: Perinatal infarcts are an important cause of neonatal neurologic morbidity accounting up to 10~20% of neonatal seizures and annual incidence rate is about one in 4,000 live births. The purpose of this study is to describe the clinical presentation, course, radiologic and Electroencephlogram (EEG) findings and to evaluate the neurologic outcome of cerebral infarcts. METHODS: Between January 2000 to May 2004, 8 of 40,204 delivered newborns (0.02%) were diagnosed as having cerebral infarcts. The clinical presentation, course, radiologic and EEG findings were characterized by retrospective chart review and neurological outcome was evaluated by neurological examination and developmental test (Bayley Scales of Infant Development-II) at out-patient department. RESULTS: There were 5 males and 3 females. Six cases of them were full term, and other 2 cases were near-term neonates. Five cases presented neonatal seizure and 3 presented apnea or respiratory distress. All cases showed abnormal finding in the cranial ultrasonography that was performed immediately after the first symptoms. After then, diagnosis of cerebral infarct was confirmed by computed tomography and magnetic resonance imaging. Abnormal EEG finding was found in the 4 cases and a correlation between the location of these abnormalities and cerebral infarcts existed. The location of infarct was on the left hemisphere in five of the 8 cases and predominantly in the distribution of the middle cerebral artery. 7 cases were followed and the mean duration of follow up was 17 months (range 3~42 months). Neurologic outcome was normal in 3 cases and abnormal in 4 cases. Mild hemiparesis was present in 3 cases and recurrent epilepsy in 1 case. Developmental test was performed in 4 cases, all of them were normal. CONCLUSION: Neonatal seizure is an important presentation as the first sign of perinatal infarcts and cranial ultrasound can be used for initial evaluation of these perinatal infarcts. Neuological sequelae remains over half of the patients. Performing long term follow-up study of large cohort study is needed.

A Case of Neonatal Adrenoleukodystrophy Presented with Neonatal Seizure / 대한소아신경학회지

Neonatal adrenoleukodystrophy(NALD) is an inherited autosomal recessive disease characterized by very early onset of neurologic deterioration, extreme hypotonia, poor sucking reflex, failure to thrive, poor or absent grasp and Moro reflexes, diminished deep tendon reflexes, neonatal seizure refractory to antiepileptic drugs, progressive hepatomegaly, and mild or absent craniofacial dysmorphism. In the peroxisomal biogenesis disorders, whose basic defect are the incapabilities to import one or more proteins into the organelle, include Zellweger syndrome(ZS), NALD, and infantile Refsum disease(IRD). These are now thought to represent a continuous spectrum of disease severity, ZS the most severe, IRD the least severe, and NALD intermediate. Furthermore, their biochemistry and microscopic pathology are nearly identical. The biochemical abnormalities of NALD are the elevated levels of very long chain fatty acid(VLCFA), phytanic acid, pristanic acid, pipecolic acid in plasma, cultured skin fibroblasts, and reduced plasmalogen contents in erythrocytes. There are no effective treatments until now. We experienced an one day old neonate with hypotonia and seizure, who was diagnosed as NALD by elevated plasma VLCFA. So we report the case with a brief review of literature.

Clinical Characteristics of Neonatal Seizures / 대한소아신경학회지

PURPOSE: Neonatal seizures are major morbidities of various neurological insults in neonates and have the predictive value for neurodevelopmental outcome. Nevertheless, it is difficult to detect seizures in this period and to verify underlying causes. In this study, we investigated the clinical features of neonatal seizures and proved the role of brain MRI in detection of underlying neurological insults. METHODS:Twenty-four patients(M:F=7:17) with neonatal seizures are recruited among 1,157 neonates born between Mar. 2004 and Jan. 2005. Seizure types are classified based upon Volpe's criteria. Retrospective reviews of medical records and interictal electroencephalograms are performed. RESULTS:Subtle seizure is the most common seizure type(9 patients:37.5%). In 4 patients, two types of seizures are noted. Among 20 patients with brain ultrasound, thirteen patients show normal findings. In contrast, out of 16 patients with brain MRI, fourteen patients have abnormal findings. Among 13 patients with normal brain ultrasound, seven patients have abnormal findings in brain MRI. Abnormal background activities of interictal electroencephalograms are noted in twenty one patients(87.5%). Subsequent seizures are detected in 3 patients. CONCLUSION:Clinical features of neonatal seizures are variable, and more than two types of seizures can be noted in one patient. Background activity of the electroencephalogram may help in diagnosis of neonatal seizures and Brain MRI should be considered in detection of underlying cause.

The Usefulness of Diffusion: Weighted Magnetic Resonance Image in the Diagnosis of Neonatal Seizure

PURPOSE: Conventional imaging study, such as CT and T1 or T2 weighted MRI, usually give valuable information, but cannot always differentiate early parenchymal lesion in the acute stage of hypoxic-ischemic brain injury from unmyelinated white matter in the neonate. Diffusion-weighted image already has been proven highly sensitive and specific for the detection of acute stroke in adult population. This study was performed to evaluate the usefulness of this technique in the diagnosis of neonatal seizure. METHODS: 11 neonates, aged from 1 to 6 days admitted at Ajou University Hospital for neonatal seizure, were studied with diffusion-weighted imaging and conventional images at within 72 hours of seizure onset. Follow-up MRIs were obtained from 4 patients at about 3 months of age. Comparisons were made among conventional T1, T2 weighted images, diffusion-weighted images and images from follow-up MRIs. RESULTS: 9 of 11 patients showed abnormal findings on diffusion-weighted images, 2 patients showed focal cerebral infarction and 7 patients showed diffuse injury consistent with HIE. Diffusion-weighted image showed more accurate images of involved lesion than T1 or T2 weighted images in some cases. But most of all, diffusion-weighted image could detect lesions of white matter injury which was not visualized on conventional MRI. The white matter injury later result in cortical atrophy and leukomalatic changes by follow-up MRI. CONCLUSION: Our study provides the usefulness of diffusion-weighted imaging in the evaluation of neonatal seizure along with conventional images. For the confirmation, a larger number of infants and clinical evaluation for development will be needed.

A Case of Incontinentia Pigmenti with Developmental Brain Malformation

Incontinentia pigmenti is a rare neurocutaneous syndrome characterized by vesiculobullous skin disease in neonates and infants, a noninfectious disease that should be distinguished from infectious diseases with the neonatal seizure or encephalopathy. This disease is X-linked dominant with Xq28 region abnormalities and often associated with developmental defects of the ocular, skeletal, dental, and central nervous system. Central nervous system involvement in the neonatal period, or complicated by encephalopathy, may cause severe neurologic impairment, retardation or even death. We experienced a case of incontinentia pigmenti in a three-day-old female patient who had characteristic papulovesicular skin lesions and partial seizures with secondary generalization. Histopathological examination favored the diagnosis of incontinentia pigmenti and a brain MRI showed undifferentiated white matters with periventricular nodular lesions.

Factros Related to the Outcome of Neonatal Seizures

PURPOSE: Seizures during the neonatal period may be an important indicator of serious neurologic abnormalities and can cause permanent neurologic sequelae. We attempted to find and analyze the factors related to the outcome of neonatal seizures. METHODS: Seventy-six newborns with seizure were reviewed. The outcomes were analyzed according to etiologic diseases, gestational ages, characteristics of seizure, and neuroimaging and electroencephalographic study findings. RESULTS: Of the 76 patients, 29 showed normal outcome, 27 had neurologic sequelae(NS), 7 expired, 7 hopelessly discharged, and 6 were lost during follow-up. Of the 40 with perinatal problems, the outcomes were normal in 19 and NS was found in 16. Of the 36 without perinatal problem, 10 showed normal outcome and 11 had NS. Ten out of 25 with hypoxia showed NS, whereas only 1 out of 11 with late hypocalcemia had NS. Of the 19 whose seizure began within the first 24 hours, 8 had NS, 3 expired and 2 discharged hopelessly. Of the 27 with generalized tonic seizures, 11 were normal and 13 showed NS. Of the 49 with brief but repetitive seizures, 16 showed NS, 6 expired and 5 discharged hopelessly. Twenty-five out of 39 with abnormal neuroimaging findings had abnormal outcomes, whereas 5 out of 20 with normal findings showed NS. Sixteen out of 27 with EEG background abnormalities and 24 out of 46 with epileptiform discharges had NS. CONCLUSION: Neuroimaging and electroencephalographic findings rather than etiologic factors were more important in predicting neurologic outcomes in newborns with seizure.