Convulsions in newborns during sleep. Convulsions in infants: symptoms, how to recognize, causes. Therapeutic methods or how to rid the baby of obsessive symptoms

Some babies have sharp involuntary muscle contractions that differ in frequency and duration. Convulsions in newborns are not always a sign of severe pathology, but the symptom cannot be ignored.

The movements of newborns are rather uncoordinated and often resemble tremors, tremors, and muscle spasms. Sometimes only a specialist can distinguish the norm from the manifestations of alarming symptoms. In any case, having found any alarming movements in the child, you should immediately contact the pediatrician.

There are several types of true seizures in infants:

1. Small, characterized by weak but prolonged muscle twitches of the face, limbs and often accompanied by a slight blue of the skin.
2. Tonic, manifested in the form of a newborn taking a tense posture with the head tilted back and a long breath hold. Most common in premature babies.
3. Clonic, observed only in full-term babies and accompanied by pronounced rhythmic contractions of certain parts of the body.
4. Myoclonic, characterized by a pronounced sharp twitching of the whole body or limbs.

Causes of seizures in newborns

1. Metabolic disorders against the background of hypoglycemia (low blood sugar levels) and hypocalcemia (acute lack of calcium in the body) often found in premature babies. The condition is dangerous with irreversible consequences for the central nervous system of the child.
2. Ischemic encephalopathy, which is a direct consequence of oxygen starvation of the infant's brain during difficult labor and complications during pregnancy (for example, in the case of preeclampsia and eclampsia).
3. Immaturity of the nervous system in premature infants, not accompanied by pathological changes in the vessels of the brain.
4. CNS infections. Often the cause of brain damage is encephalitis, meningitis, rubella, cytomegalovirus infection, acute toxoplasmosis.
5. A malfunction of the adrenal glands, leading to excessive production of norepinephrine, which is responsible for muscle spasms and uncontrollable twitches.
6. Damage to the vessels of the brain, which occurs as a result of hemorrhages in premature infants.
7. Violation of the thermal regime or an increase in body temperature during the period of the disease. Overheating of the child in the first days of life often leads to seizures. They are not dangerous and pass without a trace after the elimination of the underlying cause.
8. Intoxication against the background of hemolytic jaundice in newborns.

Convulsions in newborns are not always manifested in all of these situations. However, the following factors contribute to their occurrence:

• prematurity;
• severe illness of the mother during pregnancy;
• a woman's use of alcohol, drugs and illegal drugs;
• prolonged childbirth with complications of a different nature;
• weak labor activity, long anhydrous period;
• asphyxia as a result of entanglement with the umbilical cord and birth trauma;
• placental insufficiency.

Parental actions during an attack

It is impossible to ignore even minor manifestations of the convulsive syndrome; this can not only lead to irreversible consequences for the central nervous system, but also pose a serious threat to the life of the child. Parents should immediately consult a doctor to establish all causes, cramps, muscle spasms and eliminate them in a timely manner.

If the attack began suddenly and was accompanied by severe muscle spasms, respiratory failure, rolling of the eyeballs and salivation, it is necessary to call an ambulance. Prior to the arrival of doctors, you should:

• put the child on a flat hard surface, turning his head to one side;
• put a clean handkerchief or folded gauze between the baby's teeth;
• remove excess clothing (if the air temperature allows, undress the child to a diaper);
• open a window to let in fresh air;
• if necessary, give the baby artificial respiration;
• if convulsions are caused by high body temperature, wipe the body of the newborn with a damp sponge (vinegar, alcohol and other irritating liquids are prohibited).

A newborn is usually immediately placed in a hospital (intensive care unit or general ward of the neurological department, depending on the severity of the condition), where dangerous infections, epilepsy, and irreversible organic brain damage are first ruled out. A thorough examination includes conducting the necessary laboratory tests and instrumental studies, studying the history of childbirth and anamnesis from the mother and close relatives.

Depending on the results obtained, therapy includes the following actions:

• antibiotic treatment in case of acute infections;
• elimination of fever and normalization of body temperature;
• intravenous administration of glucose for hypoglycemia or calcium gluconate for hypocalcemia;
• drug-induced decrease in the level of bilirubin in the blood;
• hormonal treatment in case of endocrine disorders;
• artificial ventilation of the lungs when stopping and breathing disorders;
• in most cases - the appointment of anti-seizure drugs.

Primary treatment of convulsive syndrome in a child usually includes the use of barbiturates, which have a pronounced antispasmodic, anticonvulsant, sedative and hypnotic effect. As a rule, in the absence of serious diseases, the treatment lasts several days, and the manifestations of the pathology disappear without consequences. Persistent symptoms serve as a reason to prescribe more serious drugs (pyridoxine, folinic acid, clonazepam, etc.), sometimes the question of the advisability of surgical intervention is raised. After discharge from the hospital, the child is registered with a neurologist at the place of residence.

Prevention of convulsive syndrome

In order to prevent recurrence of seizures, the following preventive actions should be taken:

1. Fully follow the recommendations of a neurologist and pediatrician, give prescribed medications, carry out prescribed manipulations;
2. More often walk with the baby in the fresh air;
3. Give the child a relaxing massage and daily gymnastics;
4. Carry out hardening in the absence of contraindications;
5. Bathe the child daily in water with the addition of sea salt;
6. Observe a strict daily routine;
7. Maintain a calm, favorable environment at home, avoid stress;
8. Observe the state of the crumbs during the day.

Disease prognosis

Unfortunately, due to the impossibility of accurate, fast and reliable diagnosis of pathology in newborns, about one third of cases end in death. Another third of children develop severe consequences from the central nervous system. The prognosis is especially unfavorable in case of hemorrhages and organic brain lesions due to infections and birth injuries.

In many children, the convulsive syndrome passes easily and without a trace. It depends on the etiology of the disease, the degree of maturity of the baby and the time of the start of competent treatment from the moment of the first attack. It is important for parents to remember that the health and life of the baby does not depend on their actions.

Video of baby spasms

Convulsions in a child always look intimidating. Especially in the smallest children. Muscle spasms in a newborn or baby of the first year of life can manifest themselves in different ways, but in all cases, without exception, parents are face to face with a frightening situation in which it is not immediately clear what to do and where to turn.

We will talk about what kind of cramps the peanuts have in infancy and how to act for moms and dads in this article.

How are they developing?

Muscle spasms (cramps) are involuntary, spontaneous muscle contractions. In the process of an attack, certain muscles may be affected, and large muscle groups may be involved.

Spasms can be long and painful - tonic. And they can be combined with periods of relaxation - clonic.

All young children, from the moment of birth, are characterized by increased convulsive readiness. This term in medicine explains the tendency of the body, under a combination of certain circumstances and factors, to respond with the onset of a convulsive syndrome.

In babies, the nervous system is immature, and the load on it from the very first hours of independent existence, separately from the mother, is very serious. This often explains the increased convulsive readiness in early childhood.

The convulsive symptom in the vast majority of infants occurs only once in a lifetime, and does not recur. But there are other cases when the child grows and experiences muscle spasms from time to time. Any case of seizures needs careful study and follow-up.

Not every seizure is dangerous, not everyone is able to somehow influence the mental and intellectual abilities of the child in the future, and not every spasm contributes to the development of epilepsy.

Muscle spasms in more than 80% of newborns are caused by the influence of an unfavorable factor from the outside or are physiologically explicable and not dangerous. But there are other 20%, which include convulsive manifestations due to diseases, pathologies of the brain, nervous system, and so on.

The mechanism of convulsions in a child always lies in the violation of the close connection between the brain, nervous system and muscles. The signal from the brain may be erroneous, may not reach the desired muscle group due to metabolic disorders, due to pathologies of the nervous system.

A “failure” in signal transmission can be temporary, and the brain can quickly restore it, or it can last quite a long time.

Convulsions or the norm?

For the most part, the parents of a baby are rather hypochondriac people. And therefore, sometimes movements that have nothing to do with spasms are taken for convulsions. Consider a few quite normal and healthy situations that are often perceived by parents as manifestations of a convulsive syndrome:

• The baby suddenly shudders and abruptly throws up his arms or legs in a dream - this is the norm. The nervous system of the baby is imperfect, it is still in its infancy. Such impulses are a sign of "debugging" the work of a complex and important nervous system.
• A shaking chin, a quivering lower lip, and trembling hands while crying are normal. The reason lies again in the work of the nervous system.
• Retention of breath. Mom may notice that the baby sometimes “forgets” to inhale in a dream or holds the breath for a long time while crying - this is also the norm, which cannot be considered convulsions.

Seizures always develop suddenly, most of them - while awake. The cramp looks unnatural. For example, with weak focal convulsions, the baby can only freeze, looking at one point, and this is already considered a muscle spasm.

With some varieties of convulsive syndrome, a loss of consciousness occurs, with some, the child does not lose consciousness.

In an attack, the baby can take unnatural and bizarre poses, can involuntarily write or empty his intestines, stop breathing for a while.

To distinguish convulsions from the usual actions of shuddering, it is enough to carefully observe the baby - if there is a cycle and a certain sequence, then we are talking about muscle spasm.

Possible causes and symptoms by type of seizure

Most of the convulsions occur in newborns and infants who were born earlier than planned, because premature babies have a weaker and more vulnerable nervous system than their peers who were born on time.

Spasmodic muscle contractions in the first days and months of life always have prerequisites, only doctors fail to establish them in a quarter of cases, especially if the spasms happened once and did not recur.

The most common diseases and conditions that can lead to seizures are listed below.

Neonatal

These are muscle spasms that may accompany the first 4 weeks from the date of birth of the crumbs. This is a rather dangerous symptom, which always has adverse consequences.

The mortality rate for neonatal seizures is about 40%. Of the surviving babies, many subsequently become disabled. The cause may be birth trauma, intrauterine infection, anomalies in the structure or tumors of the brain, severe cerebral lesions of a congenital or acquired character during childbirth.

Convulsions are manifested by seizures, in which the baby suddenly freezes, throws his head back, stretches his arms, “rolls his eyes”. Breathing may stop for a while.

Febrile

These convulsions begin against the background of 12-24 hours of elevated temperature (38.0 - 39.0 degrees and above). Fever can be a symptom of any disease, and it is almost impossible to predict the development of seizures.

If the baby has ever suffered febrile convulsions, then the likelihood that they will recur with the next illness with fever is quite high - more than 30%.

Seizures are not particularly dangerous., only the wrong actions of adults during an attack can harm - attempts to keep the baby in an even position can result in fractures, and attempts to put a spoon in your mouth can result in a jaw injury.

It is not difficult to recognize such spasms in a baby - the baby loses consciousness, cramps cramps his legs, and then his arms and body, the child bends with his chin thrown back. Then the symptoms go in reverse order.

Violation of metabolic processes

Minerals and vitamins that are useful for the human body, as well as hormones, provide easy conduction of signals from the brain to muscles through nerve cells.

An excess or deficiency of certain substances cause disturbances in this interaction. So, convulsions can be observed with a deficiency of calcium, magnesium, lack of glucose, with an excess of sodium, with a lack of vitamin B6.

Symptoms in this case can be very diverse - the baby's body can suddenly tense up, or, on the contrary, relax to an unnatural state. If the child is "soft" and twitches a leg or handle, this may well be a sign lack of calcium or glucose.

Affective-respiratory

Such paroxysms are always associated with the occurrence of apnea. The baby may stop breathing due to strong emotions, with fear, for example, when the baby is immersed in water for bathing.

Convulsions may no longer manifest themselves, usually the state does not reach the loss of consciousness. This type is considered the most favorable in terms of prognosis - such apneas disappear on their own after 7-8 months, and for many - earlier.

It is not difficult to recognize such attacks in an infant - the baby at the peak of inhalation simply stops making sounds, freezes with his mouth open, sometimes the skin of the face turns blue sharply. Such a manifestation is often referred to as “went in” or “rolled up”. If general convulsions occur, they are very similar to epileptic ones.

Pathologies of the central nervous system

Damage to the central nervous system can be the result of congenital pathologies or birth injuries. Convulsive contractions of the muscles of the arms and legs are characteristic of children with hydrocephalus, craniocerebral injuries, microcephaly, cerebral palsy.

With an organic lesion of the central nervous system, for example, when the baby is exposed to toxins, toxic substances, a strong spastic attack also occurs.

Usually, convulsions are painful, frequent, the child definitely needs medical advice and treatment with anticonvulsants.

Spasmophilia

Tetany (spasmophilia) is manifested by the tendency of children with signs of rickets to convulsions against the background of metabolic disorders. Another official name for the pathological condition is rachitogenic tetany.

It usually manifests itself as laryngospasm., but sometimes it can look like convulsive contractions of the muscles of the arms, legs, face, body.

The extreme danger of tetany is somewhat exaggerated, because the tendency to convulsions disappears along with signs of rickets as the child grows. The influence of such muscle spasms on the mental and mental development of the baby has not been convincingly proven.

What to do?

When any seizures occur in children under one year old, parents should first of all call an ambulance. While the team is on call, mom and dad should refrain from using any medication.

The child must be placed comfortably laying it on its side so that it does not choke own saliva or vomit, if suddenly an attack of vomiting begins.

Convulsions in newborns or convulsive syndrome in newborns can be caused by various reasons. In the neonatal period (i.e. the first 4 weeks of life), the risk of seizures due to epilepsy is 1-3%, due to congenital brain anomalies and unsuccessful pathological births is slightly higher. The highest risk of developing seizures in premature babies is more than 20%.

Classification of seizures in newborns

Convulsions in newborns and convulsions in adults or older children have a different character due to the fact that newborn brain functions are still underdeveloped. In this regard, the nature of seizures is usually divided into several types.

Minor cramps

Small convulsions are often harbingers of serious pathologies of the brain of a newborn. The name here speaks for itself - small convulsions are characterized by minor symptoms in the form of trembling or blinking of the eye, some muscles of the face, twitching of the legs or arms, and blue skin. Such convulsions can continue for quite a long time.

tonic convulsions

Tonic neonatal convulsions of newborns are manifested in the form of muscle tension of the whole body, while the child takes an extensor posture with his head thrown back. Such convulsions are often accompanied by apnea, i.e. short breath holding. This state can last for about a minute. Most often, this attack is typical for premature babies and indicates a pathology of the subcortical-stem region of the brain.

Clonic convulsions

This type of seizure does not occur in preterm infants, but, on the contrary, is characteristic of a higher stage of brain development. Symptoms - rhythmic twitching of any part of the body with a frequency of 1-3 contractions per second.

Clonic seizures also come in three types - focal (focal), multifocal (multifocal) and generalized. The latter are characterized by loss of consciousness, cyanosis, respiratory rhythm disturbance.

Myoclonic convulsions

In newborns, they are quite rare, as they are characteristic of older children. Symptoms - a sharp twitching of the whole body or a separate limb. Mixed convulsions, such as twitching of the head and arm, are also possible. Myoclonic convulsions in newborns indicate a serious brain lesion that is hereditary or congenital.

How to determine the nature of seizures?

The movements of newborns in the neonatal period are always ambiguous, since there are also such characteristic phenomena as tremors or tremors, so the baby's twitches may not always be convulsions.

The presence of seizures and their nature is determined using an electroencephalogram (EEG), however, in newborns in the neonatal period with small seizures, it is difficult to observe characteristic changes in brain activity, sometimes they are completely absent.

There are cases when seizures do not respond to treatment with antiepileptic drugs, which may indicate that the diagnosis was incorrect, and muscle contractions and twitches are the result of nerve impulses emanating from the brainstem, which are not controlled by the cerebral cortex due to its damage.

Causes of seizures in newborns

As already mentioned at the beginning - there are many reasons for the appearance of convulsive syndrome in newborns. Let us analyze the main causes of seizures, which occur in 80% of cases.

Metabolism (metabolism) disorder

These include hypoglycemia and hypocalcemia. Hypoglycemia is a low blood sugar level that is most common in preterm infants. This condition can lead to irreversible changes in the nervous system and to cerebral lesions. Hypocalcemia is a low calcium content in the blood, which also seriously affects the central nervous system and brain of the child.

Ischemic encephalopathy and ischemic stroke

60% of cases of manifestation of a convulsive syndrome are associated with ischemic encephalopathy, i.e. brain damage associated with a lack of oxygen due to ischemia (impaired blood supply).

Central nervous system infections

These include diseases such as meningitis and encephalitis.

Cerebral vascular injury

Most often occurs in premature babies and is accompanied by hemorrhage in the ventricles of the brain, subdural and subarachnoid spaces.

Treatment of seizures in newborns

Newborns with seizures are always sent to the intensive care unit, where their condition is carefully monitored and an EEG is done. The most important thing in the treatment of convulsive syndrome is to identify the true cause, and, if necessary, adjust the metabolism, cure the infection, etc.

In the treatment of frequent, prolonged and persistent seizures, the most commonly used group of drugs called barbiturates, which are made on the basis of barbituric acid. They have anticonvulsant, hypnotic and narcotic effects, thereby depressing the central nervous system. The action of barbiturates can be short, medium and long. Long-acting drugs for the treatment of epilepsy.

In more serious cases, when the rhythm of breathing is disturbed, consciousness is lost, etc., artificial ventilation of the lungs is performed, blood pressure is maintained with the help of special preparations.

Unfortunately, due to the fact that in the neonatal period it is very difficult to identify the true causes of convulsive syndrome, 1/3 of children die. Of course, this is associated with such severe causes as meningitis, ischemic encephalopathy and ischemic stroke. In cases of convulsive syndrome caused by metabolic disorders, there is a very good prognosis. Also, approximately 1/3 of surviving children have neurological disorders.

A very common situation: literally on the first day, parents notice convulsions in a newborn child.

The spectrum of diseases that convulsions as a symptom can indicate is very wide. The most common cause is a neurological disorder, and neurological problems can last a lifetime.

Convulsions in children in the neonatal period (that is, in the period after birth) have their own specifics due to the poor development of the brain. Therefore, they are divided into types.

Minor cramps

Often they point to the prospect of pathological brain development in a child.

The symptoms are minor and often invisible to the inattentive parent:

• trembling or frequent blinking of the eye (or both eyes);
• facial muscles tremble;
• weak twitching of the arms and/or legs;
• the skin may take on a blue tint.

Small convulsions are long in time.

Tonic convulsions in newborns

What do tonic seizures look like:

• the child tenses up with the whole body;
• the newborn unbends, throws his head back;
• apnea occurs (holding the breath for a short period of time).

The above state lasts approximately one minute. Tonic spasm, as a rule, affects premature babies. Such a syndrome often indicates a pathology of the subcortical-stem region of the brain.

Clonic convulsions

This is a rhythmic twitching of one or more parts of the body. Occurs from one to three contractions per second.

Clonic seizures also have their own classification:

• Focal (focal);
• Multifocal (many convulsive foci);
• Generalized (can spread to the whole body). Loss of consciousness, cyanosis (dark bluish skin tone) and respiratory rhythm disturbances also occur.

If the previous type was more typical for premature babies, then clonic convulsions in them practically cannot occur due to the poor development of the brain.

The syndrome of clonic convulsions is characteristic of children with a more developed brain structure.

Myoclonic convulsions

What does myoclonic convulsive syndrome look like?

• twitching of the whole body or one limb;
• There may be several foci (mixed version): head and arm.

Such a convulsive syndrome indicates the presence of a serious brain lesion in a newborn. May be congenital or inherited. Occurs rarely.

Convulsions in newborns: causes

Basically, convulsive syndrome develops in newborns for the following reasons.

Due to metabolic disorders (metabolic process)

This refers to hypoglycemia and hypocalcemia.

Hypoglycemia - a pronounced lack of sugar in the blood (common in newborns and premature babies).

In the absence of proper intervention and treatment, the consequences are irreversible, because the brain is simply deprived of nutrition.

Hypocalcemia is a pronounced lack of calcium in the blood, which can also most seriously affect the central nervous system of the baby.

Due to ischemic encephalopathy and ischemic stroke

The brain is damaged due to impaired blood transport and is deprived of the amount of oxygen necessary for normal development.

due to CNS infection

A serious danger to the CNS (central nervous system) of the baby is encephalitis and meningitis. They require immediate medical intervention to avoid developmental complications.

Due to cerebrovascular disease

May develop in a premature baby. Characteristic: there is a hemorrhage in the cerebral ventricles.

Convulsions in newborns: symptoms

Of course, movements and motor skills in general in newborns are rather ambiguous and chaotic. In addition, there are tremors and tremors, which are not necessarily symptomatic. Not every twitch needs to be classified as an attack.

An electroencephalogram (EEG) can unambiguously declare a seizure. True, in a newborn, if the convulsions are small, the VEEG study may not “see” anything.

Pay attention to the behavior of the child:

• notice movements that are uncharacteristic for him;
• observe breathing - it can greatly change the rhythm, or it can even stop for the duration of convulsions;
• pay attention to unnatural posture;
• look at skin color: often the skin acquires a blue tint;
• of course, loss of consciousness should be regarded as an unambiguous symptom.

There is no need to be afraid, being at the neurologist, to talk about your observations. Only a doctor, after listening to the parents, examining the child and getting acquainted with the results of the diagnosis (with the same EEG), will be able to draw a conclusion about the presence or absence of a convulsive syndrome in the baby and prescribe the appropriate course of treatment.

Please note that the signs that are listed in this article for each type of seizures almost never speak of seizures alone. A syndrome is always a collection of symptoms. Therefore, a movement that was repeated once or twice, implicit for the baby, in no case can speak of the presence of a convulsive syndrome.

If you notice that the baby's behavior meets most of the criteria for a particular type of seizure, then do not think that "it can go away on its own."

If convulsions are left without proper treatment, this is fraught with disturbances in the development of the baby and mental retardation in the future. Contact your doctor. It is better to make a mistake and pass for too worried parents than to overlook the symptoms.

Features of the treatment of seizures in newborns

Any newborn is sent to the intensive care unit, where he is under constant supervision, and an EEG is also performed on him.

During a diagnostic study, it is extremely important to find the cause of the development of the syndrome: convulsions are not always caused by irreversible factors, it is often possible to normalize metabolism or cope with an infection. Fortunately, children's brains are as fragile as they are plastic. Successful and timely treatment can prevent the development of disorders and any traces of the disease in the future.

Frequent, prolonged and persistent convulsions are often treated with barbiturates:

• elimination of seizures;
• "oppression" of the central nervous system (no need to be afraid of this word, such a hypnotic effect allows you to stop convulsions).

The course of barbiturates can be prescribed short in duration, medium and long (for epilepsy).

If convulsions are accompanied by a violation of the respiratory rhythm, loss of consciousness, then artificial ventilation of the lungs is prescribed, and blood pressure is maintained medically.

Prevention

1. During pregnancy, pay close attention to health and the environment and surroundings to avoid infections and harmful radiation.
2. Do not take any medications without the advice of a doctor. Of course, do not drink alcohol, do not smoke.
3. After childbirth, as soon as possible, have the child examined by a neurologist. And do not forget to visit a neurologist in the future.

In addition to medicines, the expectant mother should also protect herself from “traditional medicine”.

Perhaps (if you are planning a pregnancy), a few months before conception, a woman may be advised to take folic acid as a prevention of seizures in an unborn baby. It is important to note that consultation with a neurologist is necessary, no matter how healthy the child looks, even if there are no referrals from other doctors. Because some diseases may not develop immediately after birth, but after some time.

Related video

Frequency. Approximate incidence of clinically visible seizures:

• 0.7-2.7/1000 newborns.
• 57.2-132/1000 newborns weighing< 1500 г.
• 90% of these cases - in the first 2 days of life.

Causes and Risk Factors for Cerebral Seizures in Newborns

Ischemia, hypoxia, shock.

Intracranial hemorrhage.

Infections, meningitis, sepsis, congenital infections.

Brain infarction.

Metabolic disorders:

• Exclude hypoglycemia, hypocalcemia, hypomagnesemia, hyper- or hyponatremia.
• Amino acid metabolism disorders, peroxisomal disorders.
• Acute neurological disorders (convulsions, impaired consciousness, vomiting, muscle hypotension and paresis).

Familial neonatal convulsions.

Drug withdrawal syndrome.

Theophylline overdose.

Maternal diabetes.

Attention: the etiology of more than 25% of seizures remains unclear. Approximately 30% of seizures in term newborns and 50% of seizures in preterm infants are caused by perinatal complications.

Classification, symptoms and signs of cerebral seizures in newborns

Mild seizures: the most common form of seizures in preterm infants.

• Persistent eye opening with a fixed position of the eyeballs (preterm) or tonic horizontal deviation of the eyeballs (term), nystagmus, eyelid tremor or flutter.
• Sucking, smacking, salivation, grimacing, hiccups.
• "Swimming", "pedaling", "rowing".
• Changes in skin color, blood pressure, heart rate and breathing rhythm, sudden deterioration in breathing, including with machine breathing.

Clinical seizures: slow (1-3 per second) rhythmic twitches of individual (focal) or multiple muscle groups that are not caused or suppressed by external stimuli.

Tonic convulsions: prolonged contractions of muscle groups of the neck, trunk or limbs, focal or generalized

Myoclonic spasms: rapid short-term flexor contractions. There are focal, multifocal and generalized.

Attention: Every sudden change in clinical condition may be an attack of seizures, especially if they recur.

Differential diagnosis and diagnosis of cerebral seizures in newborns

Benign neonatal myoclonus; in a dream is not an attack of convulsions! Characterized by short myoclonuses, primarily in the phase of falling asleep, which can be interrupted.

Maternal history (eg, drugs, food).

History of childbirth (asphyxia, trauma, intoxication due to the use of local anesthetics in the mother).

Thorough clinical examination.

Laboratory indicators:

• Sodium, potassium, calcium, magnesium, chlorine, phosphate.
• Glucose, blood gases, C-reactive protein.
• Hematocrit, platelets, serum bilirubin.
• Urea, creatinine, coagulogram, ammonium, liver enzymes.
• General urine analysis.
• Screening for TORCH (toxoplasma, rubella, CMV, herpes), better than PCR.
• Blood and urine amino acids, pyruvate, lactate, pyridoxal-5-phosphate, etc.
• Vitamin B 12 in older infants and in the exclusively vegetarian diet of the nursing mother.
• Blood cultures.
• With an unclear etiology of seizures and suspicion of metabolic disorders.
• Drug screening for maternal abuse.

Lumbar puncture (cytosis, protein, glucose, bacteriology and virology).

ECG: QT prolongation (hypocalcemia, less often with hypokalemia).

Cranial ultrasound.

Ophthalmological examination

EEG: if possible, baseline, treatment control, at discharge:

• Standard EEG - to exclude epileptiform activity.
• Amplitude-integrated EEG - for long-term monitoring in the intensive care unit. Focal low-amplitude and very short episodes of activity may remain unrecognized.

Perhaps CT, MRI (subdural / epidural hemorrhage, malformation, thrombosis of the venous sinus).

Treatment of cerebral cramps in newborns

Ensuring adequate breathing, possibly respiratory support / ventilation, oxygen therapy.

ECG monitoring, blood pressure control.

venous access.

Especially with recurring and prolonged convulsions - ensuring sufficient glucose intake.

Antibacterial/antiviral therapy for suspected meningoencephalitis.

Tension hydrocephalus: relieved by puncture or shunting.

If SNS ADH is suspected: Consider fluid restriction (70% of normal).

beware breeding hyponatremia.

beware decrease in perfusion pressure due to hypovolemia.

For hypoglycemia:

• 0.5 g/kg glucose.
• Then long-term infusion of glucose 8(-16) mg/kg/min.

For hypocalcemia: 0.5 mmol / kg = 2.2 ml / kg of 10% calcium gluconate for 10 minutes intravenously.

For hypomagnesemia: 0.3 mmol/kg = 1 ml/kg 10% magnesium aspartate (for example, 10% magnesiocardium) IV slowly.

First of all, in mature newborns - pyridoxine 100 mg IV.

Anticonvulsants

The main question “does seizures lead to additional brain damage” has not yet been finally resolved.

Lombroso/Freeman: No additional damage, no vital disturbances.

Volpe/Gluckman: Repeated neonatal seizures lead to brain damage. Therefore, immediate treatment of all clinical seizures is convulsions.

Study on the effects of seizures in animals:

• Increased tendency to convulsions later in life.
• Structural changes in the limbic system.
• Limited ability to learn and recognize.

In children during seizures, there is an increased cerebral blood flow after seizures, the neurological outcome worsens.

Extremely variable individual pharmacokinetics.

Frequent use is preferred due to less fluctuations in blood concentrations and less risk of toxicity.

The goal of anticonvulsant therapy is to interrupt symptomatic seizures, not every seizure activity.

Current Cochrane reviews indicate a low evidence base for the use of all anticonvulsants in neonates. The following approach is suggested:

Primary treatment for seizures:

Phenobarbital (luminal):

• The half-life depends on the duration of treatment: 2 weeks - 103 hours, 3 weeks - 65 hours, 4 weeks - 45 hours.
• Side effects: hypotension, apnea.
• 50-70% of seizures are treatable with phenobarbital.

Phenytoin (fengidan):

• The initial dose is 5-10 mg/kg over 10-15 minutes IV slowly or as a short infusion.
• Repeat after 5-10 minutes.
• The maintenance dose is 3-5 mg/kg per day intravenously or later orally in two divided doses.
• The half-life varies (premature 75±65 hours, full-term 21±11 hours), so it is necessary to control the concentration in the blood.
• Side effects: AV block, bradycardia, hypotension, ECG monitoring! Treatment is atropine 20 mcg/kg IV. Bleeding tendency (vitamin K), vitamin D deficiency, vomiting.

Attention: before and after the injection of the drug, the catheter should be washed with 0.9% NaCl. For prolonged infusion, use a separate access! The maximum infusion rate is 1 mg/kg/min.

Caution: Paravasal administration leads to severe tissue necrosis!

For ongoing seizures: elimination of deficiency of pyridoxine, pyridoxal-5-phosphate or folinic dependence.

Pyridoxine for vitamin B6-dependent seizures:

The initial dose is 100 mg IV bolus, if there is no response, further IV administration every 5-10 minutes is possible. 100 mg to a maximum total dose of 500 mg.

Pyridoxine should be given to neonates for all unclear or persistent seizures.

Lumbar puncture, if possible, prior to pyridoxine administration.

When responding to vitamin B 6, the determination of glutamate, GABA and pyridoxal-5-phosphate in a pre-collected portion of cerebrospinal fluid (follow the recruitment rules). Additionally, determine pyridoxal-5-phosphate in erythrocytes.

Maintenance dose: replacement of vitamin B 6 15-30 mg / kg per day orally until the effect is obtained or for several weeks until the absence of a therapeutic effect is verified.

If you respond to vitamin B 6, stop other anticonvulsants.

With no effect:

Pyridoxap-5-phosphate (n-5-p) with pyridoxal phosphate-dependent convulsions. In this recently described condition, convulsions do not stop when vitamin B 6 is administered. Leading symptoms may be: lactic acidosis. signs of birth asphyxia, elevated glycine and threonine. Initial dose: pyridoxal-5-phosphate 30 mg/kg per day for three injections, the effect is manifested within 3-7 days. Dose for long-term therapy: 30-50 mg / kg per day in 3-5 doses. With no effect:

folinic acid. Dose 3-5 mg/kg IV (single dose) for 3 days. Sometimes used in combination with n-5-ph. If effective, lifelong oral administration is required.

Carefully: after intravenous administration of pyridoxine, apnea is possible!

If vitamin B 6, its metabolites and folinic acid are ineffective has the maximum therapeutic blood level of phenobarbital or phenytoin been reached (check concentration)?

Phenobarbital and phenytoin are recognized as first and second line drugs. Supplementation with pyridoxine, n-5-p, and folinic acid may help, despite the rarity of dependent seizures. There is no consensus on which anticonvulsants and in what order to use next for persistent seizures. It is possible to use the following drugs:

Clonazepam (rivotril).

• Elimination half-life: 20-43 hours.
• Therapeutic serum level: 20-40 (-60) mcg / ml, however, the relationship between concentration and effect has not been reliably confirmed.
• Side effects: increased salivation, injection contains alcohol.

Lorazepam (tavor):

• The initial dose and maintenance dose of 0.05 mg/kg over 2-5 minutes IV may be repeated.
• It acts longer than diazepam and does not accumulate, it depresses breathing less.
• Side effects: myoclonus and stereotypic movement pattern (described in some preterm infants).

Diazepam (diazemuls).

• Diazepam is used less and less because it has no advantages over phenobarbital: the anticonvulsant effect is short and the half-life is long.

Beware of respiratory depression!

External: Valium cannot be used because it contains sodium benzoate, which displaces bilirubin from albumin!

Midazolam (dormicum).

• Initial dose of 0.1-0.15 mg/kg over 10 minutes IV, may be repeated.
• - Maintenance dose 0.1(-0.4) mg/kg/day.

Carefully: Side effect: may cause convulsions (more common in preterm infants, especially when administered rapidly). Therefore, it is administered slowly under close supervision.

Lidocaine:

• Used only for seizures refractory to other treatments.

Although newer anticonvulsants (levetiracetam or topiramate) have already been used in term and preterm infants, little experience has yet been made to make general recommendations.

Duration of treatment

Individual, since there is no proven data on the required duration of treatment.

For as short a time as possible; depending on the etiology, findings on the EEG and observational data.

With convulsions in preterm infants on the first day of life and with an unclear etiology, drugs can be canceled quickly, within a few days after convulsions.

Forecast

Depends on the etiology, to a lesser extent on the degree of immaturity of the child. Children who respond to a single drug generally have fewer problems and a better prognosis than children who require multiple drugs.

Even experienced doctors should not give a prognosis.

Attention: Prepare well for a conversation with parents, involve experienced colleagues! It is important to provide truthful information based on verified facts.