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Neonatal Seizures: Diagnosis, Etiologies, and Management 31/07/2020 https://www.medscape.com/viewarticle/929063_print https://www.medscape.com/viewarticle/929063_print 2/12 hypothermia. [14] Identification of seizures in HIE is imperative, as they occur in 25 to 50% of neonates with HIE and may exacerbate the underlying brain injury. [15–17] Seizure semiology varies based on the region of brain injury, but there is a high prevalence of subclinical seizures in neonates, which underscores the need for electroencephalography (EEG) recording as discussed later. Table 1. Causes of neonatal seizures Etiology Frequency a Seizure onset Hypoxic–ischemic encephalopathy 38% First 24 h Ischemic stroke 18% First week Intracranial hemorrhage 12% First week Genetic syndrome (including benign familial neonatal epilepsy) 9% In utero to weeks Intracranial infection 4% Days to weeks Brain malformation 4% Variable Transient metabolic 4% First few days Inborn errors of metabolism 3% Day 2+ Others/unknown 9% variable aAmong a large cohort of 426 consecutive neonates with seizures. 53 Cerebrovascular events are the second most common cause of neonatal seizures. Arterial ischemic perinatal strokes are typically the result of embolism from the placenta or umbilical cord, carotid artery, or heart. Maternal risk factors include oligohydramnios, chorioamnionitis, premature rupture of membranes, preeclampsia, diabetes, and smoking. Neonatal risk factors include congenital cardiac abnormalities, systemic infection, coagulation disorders, placental abnormalities, and male sex. Seizures resulting from focal strokes often present somewhat later than those caused by neonatal HIE, frequently up to 24 to 48 hours after birth or later. [18–20] The seizure semiology among neonates with perinatal arterial ischemic strokes is classically focal clonic seizures due to involvement of the motor cortex in the middle cerebral artery territory. ICH can cause acute symptomatic seizures, with severity and semiology determined by the size and location of the hemorrhage. Subdural hemorrhage in the anterior and middle cranial fossae may have associated subarachnoid hemorrhage and may result in seizures. Parenchymal hemorrhages frequently cause seizures, and are often caused by underlying vascular malformations. Intraventricular hemorrhages rarely cause seizures in term infants unless the hemorrhage is large and involves parenchymal injury. [19] However, ICH is the second most common etiology of seizures in preterm infants (<32 02789176="" 1.="" 100="" 13="" 15="" 1="" 2.="" 20="" 24="" 25="" 28="" 2="" 3.="" 30="" 31="" 3="" 4.="" 40="" 41="" 48="" 4="" 4th="" 50="" 5="" 60="" 66="" 6="" 6th="" 7.5="" 75="" 7="" 80="" 8="" 96="" 9="" a="" abate="" abbreviations:="" abnormal="" abnormalities.="" abnormalities="" abnormality="" about="" access="" accompanied="" accurate="" accurately="" acid="" aciduria="" acquired="" active="" activity.="" acute="" addition="" additional="" additionally="" adequate="" administered="" administration.="" administration="" advancement="" advances.="" advances="" adverse="" affect="" affected="" affecting="" after="" age-specific="" age.="" age="" agent.="" agent="" agents.="" agents="" aid="" albumin="" aldh7a1="" algorithm="" algorithms="" all="" allocation="" allow="" alone.="" along="" also="" alteration="" alters="" american="" amino="" among="" amt="" an="" and="" animal="" anomalies="" 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