ETIOLOGICAL, CLINICAL AND EEG PROFILE OF NEONATAL SEIZURES- AN INSTITUTIONAL STUDY

Dr. Roshith J. K.* and Dr. K. N. V. Prasad

ABSTRACT

Background: The occurrence of seizures may be the first indication of a neurological disorder in the neonate. A correct mode of resuscitation soon after birth at first minute of non-vigorous baby, proper monitoring and management of seizure during the post- resuscitation care babies can prevent further occurrence of seizures, deterioration of low agar babies in neonatal care unit and this also helps in better outcome which avoids morbidity, mortality and associated sequel of neonates with seizures. A proper documentation of seizure and clinical profile of seizure can also help with earlier determination of etiology of seizure and help in proper management of the same. Hence this study has been taken up to determine clinical seizure profile, etiology of seizures, bio-chemical and EEG abnormalities in neonatal seizures which would help in early recognition, treatment and better prognosis in neonatal seizures. Objectives: 1. To characterize the clinical profile of neonatal seizure. 2. To identify the etiological profile of neonatal seizure. 3. To perform EEG in neonatal seizure and correlate the clinico-etiological profile. Material and methods: A total of 68 inborn and outborn neonates with seizure were enrolled in the study from Januray 2015 to January 2016. Data including gestational age, birth weight, antenatal events, perinatal events, apgar score, mode of resuscitation, clinical profile like age of onset of seizures, duration of seizure, episodes of seizure, drug used to abort seizure, type of convulsion, seizure associated autonomic changes, lab investigation reports like complete blood count, C-reactive protein, serum biochemistry, cerebro-spinal fluid study –etiology profile of seizure was evaluated, electro encephalogram was performed as soon as early as possible and all were documented in proforma. Results: Of 68 neonates with seizures were included in the study. In the study 91.2% of the neonates were term babies and 8.8%. Male predominance was observed. Out of the neonates enrolled 73.5% of neonates with seizure had low apgar & 77.9% of neonates with seizure who required intermittent positive pressure ventilation were admitted for post -resuscitation care in NICU. In the study 61.7% of neonates had seizures at less than 12 hours of life. Focal clonic type of seizures was more observed (67.2%) as compared to other types. Hypoxic Ischemic Encephalopathy (HIE-II) was a major etiology in the study 42.6%. Among 18 EEG done on neonates with seizures, two had an abnormal EEG pattern. Limitations: In my study EEG could not be performed in all neonates who had seizures due to various reasons. Conclusions: In the present study of etiology in neonatal seizures showed that Hypoxic ischemic encephalopathy -II was the common etiology in 29 neonates (42.6%) and the second major etiology noted in 13 babies (19.1%) was hyponatremia. Focal clonic type of seizure was seen in 67.2% neonates as a common clinical profile of seizure.

Keywords: Electroencephalography (EEG), Hypoxic ischemic encephalopathy, Perinatal Asphyxia.