Neonatal Seizure Cases. Courtney Wusthoff, MD MS Assistant Professor, Neurology Neurology Director, LPCH Neuro NICU

Transcription

1 Neonatal Seizure Cases Courtney Wusthoff, MD MS Assistant Professor, Neurology Neurology Director, LPCH Neuro NICU

2 Disclosures I have no conflicts of interest I will discuss off-label use of anti-epileptic drugs (AEDs) for treatment of neonatal seizures

3 Acknowledgements Nick Abend Bob Clancy Don Olson

4 Learning Objectives At the conclusion of this activity, participants should be able to 1. Recognize the terminology used to describe clinical seizures 2. List at least three features to help clinically distinguish seizures from mimics

5 Overview Describe what you see Look for clues Go to the trace Put your nickel down Wusthoff 2017

6 Describe what you see Generalized Tonic- Clonic Seizure

7 Describe what you see Generalized Seizures Tonic-clonic Clonic Typical absence Atypical absence Myoclonic absence Tonic Spasms Myoclonic seizures Eyelid myoclonia (with or without absences) Myoclonic atonic Negative myoclonus Atonic Reflex seizures in generalized epilepsy Focal Seizures Focal sensory Focal motor Elementary clonic motor Asymmetric tonic motor Temporal lobe automatisms Hyperkinetic automatisms Inhibitor motor seizures Gelastic Hemiclonic Secondarily generalized Reflex seizures in focal epilepsy ILAE Seizure Terminology

8 Describe what you see Generalized Seizures Tonic-clonic Clonic Typical absence Atypical absence Myoclonic absence Tonic Spasms Myoclonic seizures Eyelid myoclonia (with or without absences) Myoclonic atonic Negative myoclonus Atonic Reflex seizures in generalized epilepsy Focal Seizures Focal sensory Focal motor Elementary clonic motor Asymmetric tonic motor Temporal lobe automatisms Hyperkinetic automatisms Inhibitor motor seizures Gelastic Hemiclonic Secondarily generalized Reflex seizures in focal epilepsy ILAE Seizure Terminology

9 Describe what you see Descriptor Clonic Tonic Clinical Appearance Rhythmic movements of muscle groups Fast and slow components to movement Frequency typically 1-3 jerks per second Sustained flexion or extension of axial and/or appendicular muscle groups Myoclonic Single or multiple rapid jerks of extremities Focal (including Subtle ) Subclinical Ocular tonic deviation of eyes, sustained eye opening, ocular fixation, or fluttering Oral-facial-lingual movements chewing, tongue thrusting, lip smacking Limb movements cycling, paddling Autonomic phenomena tachycardia, bradycardia, apnea No outward clinical signs; diagnosable only with electrophysiologic monitoring

10 Clues for Seizure vs Mimic Seizures Seizure Mimics Provoking factors No clear provoking cause Happen while awake or asleep Triggered by touch (clonus) Happen only in sleep (benign sleep myoclonus) Duration Lasts a few seconds to a few minutes Prolonged without stopping Quality Stereotyped: similar each time Appears different each time an event occurs Eye involvement Eyes typically open Eyes sometimes deviated Eyes remain closed Alertness Baby unresponsive during episode Baby remains otherwise alert with typical behavior during episode Ability to suppress Cannot be stopped by picking baby up or suppressing limbs Can stop by waking baby (benign sleep myoclonus) Can suppress by holding limb (clonus)

11 Clues for Seizure vs Mimic Clonic seizure Myoclonus Jitteriness Seizures? Yes Sometimes (can be benign variant, seizure, or a release phenomenon) No Semiology Repetitive, rapid phase followed by slow return phase Very rapid, monophasic, without a return phase; can be isolated or repetitive Repetitive; both the movement and return phase rapid; usually low amplitude and high frequency Location Usually focal; can spread to other areas over course of seizure Can be focal, multifocal, or generalized Tends to be multifocal or affect parts of the body that are not restrained Rhythmic? Yes No Yes Suppressible with light touch? No Benign myoclonus can be suppressed but myoclonic seizures cannot Stimulus induced No Sometimes Yes Yes, especially with flexion of joint Diagnosis Clinical picture is highly suggestive, but EEG confirms diagnosis Benign sleep myoclonus can be diagnosed clinically; seizures require EEG Clinical picture is usually adequate to diagnose

12 Sudden Repetitive Evolving Frequency Voltage Morphology Location Duration 10 seconds No minimum frequency Go To The Trace

13 Put Your Nickel Down! Be reassured Ask for help Start aeeg or ceeg Treat empirically

14 Questions?