1. Children's Hospital of Michigan
Neonatal Seizures
Eishi Asano, MD, PhD, MS
Associate Professor of Pediatrics and Neurology Wayne State University School of Medicine  Director, Electroneurodiagnostic Lab
Children's Hospital of Michigan

2. In childhood, the risk of seizures is highest
in the neonatal period
(1.8 to 3.5/1000 live births in the United States).
Is this description true?

3. Yes.

4. Neonatal seizures are associated with high mortality and morbidity rates, and their ultimate outcome is strongly influenced by their underlying cause
(rather than EEG findings or type of antiepileptic treatment).
Is this description true?

5. Yes, Underlying etiology >> EEG findings
Data from both human and animal studies suggest that seizures amplify neonatal hypoxic-ischemic brain damage.

8. When you read neonatal EEG, which of the followings are very important and must be included into the report?
(1) Age
(2) State
(3) Background
(4) Interictal spike discharges
(5) Neonatal seizures

9. Subclinical seizures are common in several NICU populations, including severely asphyxiated infants and preterm infants with development of intraventricular hemorrhage.
Clinical correlates occur in 20% to 80% of EEG studies in neonates, and in the busy NICU setting, clinical seizure recognition may be even lower than that estimated from the review of EEG data.
Is this description true?

10. Yes. Thus, some investigators emphasize the importance of
video-EEG in infants suspected of neonatal seizures.

11. A 41-week-CA neonate (33 + 8 weeks) Is it a part of seizure?
Fp3-T3
T3-O1
Fp3-C3
C3-O1
Fp4-T4
T4-O2
Fp4-C4
C4-O2
A1-T3
T3-C3
C3-Cz
Cz-C4
C4-T4
T4-A2
LOC
ROC
EMG
EKG
RESP

12. Yes

13. Is it a part of seizure?

15. How about this?

16. Brain & Development 30 (2008) 261–268

17. How about this?

18. Neonatal seizure.
Clin Neurophysiol 2007;118:

19. Is it a part of seizure?

20. Yes
Clinical Neurophysiology 119 (2008) 1248–1261

21. Is it a part of seizure?

22. Yes, this seizure consisted of unilateral, occipital, slow, sharp wave activity.
Pediatrics Jun;121(6):

23. Is it a part of seizure?

24. Yes.
Focal ictal discharge beginning in the right occipital region. The EEG background activity is low voltage. This EEG is from a preterm infant, born at 30 weeks GA with Listeria meningitis. Calibration 1 s and 70 lV.
F. Pisani et al. / Brain & Development 30 (2008) 20–30

25. Is it a part of seizure?

26. No. These were thought to be related to electrode, patting, and muscle artifact
Pediatrics Jun;121(6):

27. Is it a part of seizure?

28. No. These were thought to be related to electrode, patting, and muscle artifact
Pediatrics Jun;121(6):

29. Is it a part of seizure?

30. No. These were thought to be related to electrode, patting, and muscle artifact
Pediatrics Jun;121(6):

31. Benign Neonatal Epilepsy

32. ?
Benign neonatal epilepsy is an autosomal dominant disorder
characterized by clusters of seizures occurring in the first days of life.

33. Benign neonatal epilepsy is an autosomal dominant disorder
characterized by clusters of seizures occurring in the first days of life.
Most patients have spontaneous remission by 12 months of age.

34. Underlying mutations?

35. KCNQ2 gene
20q
KCNQ3 gene 8q
K is what K?

36. M-type potassium channels

37. KCNQ2 gene
20q
KCNQ3 gene 8q
Such mutations are specific to benign neonatal epilepsy?