Study of neonatal seizures;clinical presentation,etiology and outcome

SUMMARY AND CONCLUSIONA total of 50 patients with neonatal seizures of different etiological factors were studied and divided into 3 groups; fullterm (42) cases, preterm (7) cases and (1) case post date . They were collected from neonatal ICU of Zagazig University Hospital between the period of October 2002 to October 2003.The cases were subjected to proper history taking ,full clinical examination, laboratory investigations, and CT scan was carried out for all cases .Neonatal seizures are sure sign of brain injury in neonates .In our study we found that hypoxic –ischemic encephalopathy is the most common cause of neonatal seizures and intracranial Hge, intracranial infection, congenital anomaly, and metabolic causes come later.Most preterm cases presented with subtle siezures and the majority of fullterm cases varied between generalized tonic or clonic seizures , this difference in the type of seizures beween preterm and fullterm is due to rapid increase in the development of brain tissue cells and according to the site and the extent of cerebral lesions.CT with its sensitivity contributes important information about the time of occurance and nature of the neuropathology underlying seizure activity.CT yields significant information about assessing the extent of hypoxic– ischemic brain damage during the early postnatal period and later infancy and is critical to prognosis.Not all cases with hypoxic – ischemic encephalopathy had abnormal CT findings, where of ( 33 ) cases with clinical sign of hypoxic – ischemic encephalopathy, (10) patients had normal CT findings and (9) of those cases were neurologically normal at short term follow up.The cases with subtle seizures controlled by phenobarbitone orally or intravenously while most fullterm seizures controlled by loading doses of phenobarbitone and /or phenytoin followed by maintenance daily doses, sometimes we had to add diazepam to control some refractory cases.The cases were subjected to neorological examination after three months and the results were as follow :1- 35 cases were normal (70%) without complications2- 4 cases developed hydrocephalus .3- 1 case showed hypotonia of limbs and trunk muscles4- 10 cases died during the 1 st three months .We recommend ,Proper antinatal, natal and post natal care, usage of new gynacological techniques are valuable for prevention of physical and mental handicapping in children .Having an early definite diagnosis in neonatal seizures with clear anatomical definition is of great help with clinical management , prognosis and generally helps to alleviate the parenteral distress.The less the cerebral lesion, the good the outcome and the less the neurological sequelae .NO Sex Mode of delivery Natalhistory Post-nhistory Apgar1-5 min Convulsions Treatment Etiology C T brain Out-come H.CType Onset Frequ. Drug Dose1 M V D 3 N.R R .D 4 – 6 G .C D 3 1/ h Pheno 8/iv Ischemic Normal Died 352 M V D 2.250 N . R R . D 3 – 5 Subtle 1 Hour 1/2h Pheno 8/iv Ischemic Normal Good 353 M C S 3 PROM2 days PurpuricEruption 5 – 9 G . T D 5 7/h 3drugs Iv Hge Hge Dis-ability 344 F Assis V D 2.750 N . R Asphyxia 1 – 3 G . C D 1 15/h 3drugs Iv Ischemic D C H Died 335 M V D 2 --------- An-encephaly 4 – 7 G . T 1 Hour 1/3h Pheno 10/iv Cong-enial Cong-enial Died -6 F V D 2.5 -------- R . DSepsis 8 – 10 G . T D 9 1/h PhenoPheny 810/ iv Hge Hge Good 347 F C S 2.300 -------- R . D 5 - 8 Subtle 1 Hour 1/3h Pheno O Ischemic Normal Good 358 M V D 3.750 Ante-PHge Asphyxia 3 –7 G .C D 3 1/2h PhenoPheny 810/ iv Ischemic D C H Good 359 M Assis. V.D 2.750 Obstructed head R.D 5-8 GC D4 1/h phenobarb 8/i.v Ischemic M C H Died 3410 M C S 3.5 Post date , 2 Weeks R.D 6-8 GC D9 1/h Pheno pheny 810-i.v Ischemic D C H Good 35