SEIZURES - NEONATAL

Definition: Convulsive fits or spasms during the first month of life.

1. What is a seizure?

A seizure is a clinical event (episode) that is the result of excessive activity of a group of nerve cells (neurons) in the brain. There are many different types of seizures (staring, turning the body to one side, jerking of the arms and legs, etc.). The type of seizure a baby has depends upon the baby’s age and the part of the brain that the seizure is coming from. Also, the cause of the seizure may determine the type of seizure a baby has.

2. What causes seizures in babies?

Anything that can cause the brain not to work normally can cause a seizure. Common causes in babies include not getting enough blood and oxygen to the brain, bleeding in the brain, infections of the brain, strokes (when the blood flow to a part of the brain is cut off), metabolic problems (such as low blood sugar or calcium), abnormalities in how the brain is formed, inherited problems, or drug withdrawal (such as if the mother used certain drugs or alcohol during the pregnancy especially on a regular basis). There are other less common causes as well.

3. How are seizures treated, and how effective is the treatment?

Treatment depends upon the cause of the seizure. For example, if the blood sugar is too low, giving sugar typically solves the problem. Sometimes it is necessary to give medication to stop the seizures. The more commonly used medications include diazepam (Valium), lorazepam (Ativan), phenobarbital, and phenytoin (Dilantin). The effectiveness of these medicines at stopping seizures is mainly dependent upon the cause of the seizures. Similarly, how long the baby will need to stay on the medication(s) is often dependent on the cause of the seizures.

4. Are there any side effects to the medicines used in the treatment?

Like any medication, there is always the possibility of side effects. In general, these medications are quite safe. The most common side effect is sleepiness (sedation). This will usually go away once the baby gets used to the medication (typically in three to seven days).

5. What potential harm can the seizures have, and can they cause brain damage?

Many times, it is the presence of brain damage (such as stroke, infection, bleeding in the brain, trauma, and malformations of the brain) that cause the seizures. In these cases, it is the underlying problem that causes brain damage, not the seizure. In some instances, however, especially if the seizures are very long (greater than fifteen to thirty minutes), or they are very frequent, they may cause brain damage.

6. What tests do we need to do to establish any possible underlying cause?

What testing your baby may need will be determined by the circumstances around your baby’s seizures. It is likely that your baby will have some blood and urine tests. If it is found that your baby has low blood sugar and giving your baby some sugar solves the problem, then no other testing may be needed. If the doctor is worried about infection, it is likely that he or she will do a spinal tap. If the blood tests are normal and there is not an obvious cause for the seizure, it is likely that your doctor will want to look at your baby’s brain, either with a CT or MRI head scan. Your doctor may also want to get a brain wave test (electroencephalogram or EEG).

7. Do you think that the seizures will recur, and what are the possibilities that my baby will outgrow them? 

Whether or not the seizures will recur is in large part due to the cause of the seizures. Babies that have had lack of blood or oxygen to brain, strokes, trauma, and conditions where the brain did not form normally tend to have seizures that can be hard to stop and often come back later in life. Babies that are normal except for a family history of seizures in early life or that have had low blood sugar or calcium as the cause of their seizures often do very well, and the seizures typically do not come back.

8. Do we need to consult with a neurologist?

This depends on the cause for the seizures. Babies that have low blood sugar or low calcium as the cause for their seizures do not typically need to be seen by a neurologist. When more serious conditions like stroke, trauma, abnormalities in brain formation, or lack of oxygen occur, follow-up with a neurologist is a good idea.

9. Are there any precautions we need to take when we go home, such as connecting my baby to an apnea monitor?

In most cases, unless there are complicating problems (breathing problems, swallowing problems, etc.), there is no need for special monitoring or precautions. Typically, treating your baby as you would any other newborn is all that is needed.

10. When do you wish to see my child again regarding this condition following discharge?

When your baby needs to return for follow-up will be dependent on the cause of your baby’s seizures. Normally, we will see your baby two weeks after discharge from the hospital. If you see a neurologist in the hospital, he or she will arrange for follow-up if needed. Many times, if follow-up is required, he or she will ask to see your baby one to three months after discharge, but again, this will be determined in large part by the cause of your baby’s seizures. 

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