Rufo-Campos M
Sección de Neuropediatría, HIU Virgen del Rocío, Sevilla, España.
Rev Neurol. 1999 Jan;28 Suppl 1:S29-33.
Neonatal convulsions are usually symptomatic and originate mainly from a hypoxic-ischemic (H-I) lesion. The high incidence of crises and their serious sequelas have led us to carry out this retrospective study.
We studied 54 histories of neonatal H-I and epileptic crises, analyzing 45 variables and evaluating their diagnostic concordance.
In 20 children meconium was detected during gestation and, to a lesser extent, infection and hemorrhage. Birth was dystonic on 48 occasions, 37 at term and 12 preterm. In most cases (27) birth weight was in accordance with gestational age. Apgar scores were always less than 5. The crises, occasional or daily in most cases, were of subtle semiology in 29 children, followed by generalized tonic (23), focal clonic (13), general clonic (11), multifocal clonic (7), focal tonic and multifocal myoclonic (6), focal myoclonic (4) and generalized myoclonic (2) crises. Only 7 EEGs were done during crises (1 normal, 3 with anomalies and 3 with slow basal activity). Paroxystic anomalies were only found on 10 EEGs done between crises. Cerebral echography was the method most used and most useful. Very frequently changes were observed in other organs as the expression of a multisystemic disorder. Most children had abnormalities on neurological examination. In most cases, classical anti-epileptic drugs were used intravenously, and new generation drugs were given if the crises persisted. After an average of 16-19 months of follow-up, 13 children had died and 34 no longer had crises. However, only 20 of the surviving children were considered to be normal, 14 had severe mental retardation, 6 moderate and one slight retardation.
Neonatal H-I is the main cause of epileptic crises in the RN period, with a high percentage mortality and severe neurological sequelas. The crises are usually well-controlled by classical anti-epileptic drugs, and are an excellent marker, together with the Apgar score and gestational and placental changes. The appearance of normal EEGs during periods of crises should make us doubt the authenticity of subtle crises, perhaps corroborated by a good therapeutic response.
新生儿惊厥通常是症状性的，主要源于缺氧缺血性（H-I）损伤。惊厥的高发病率及其严重后果促使我们开展这项回顾性研究。
我们研究了54例新生儿H-I和癫痫发作病史，分析了45个变量并评估其诊断一致性。
20名儿童在孕期检测到胎粪，感染和出血的情况较少。48次分娩为张力异常，37次足月分娩，12次早产。大多数情况下（27例）出生体重与孕周相符。阿氏评分始终低于5分。大多数情况下惊厥为偶发或每日发作，29名儿童的惊厥表现为细微的发作形式，其次是全身性强直发作（23例）、局灶性阵挛发作（13例）、全身性阵挛发作（11例）、多灶性阵挛发作（7例）、局灶性强直和多灶性肌阵挛发作（6例）、局灶性肌阵挛发作（4例）和全身性肌阵挛发作（2例）。惊厥发作期间仅进行了7次脑电图检查（1次正常，3次有异常，3次基础活动缓慢）。发作间期仅10次脑电图检查发现阵发性异常。脑超声检查是最常用且最有用的方法。经常观察到其他器官的变化，作为多系统疾病的表现。大多数儿童神经系统检查有异常。大多数情况下，静脉使用经典抗癫痫药物，若惊厥持续则给予新一代药物。平均随访16 - 19个月后，13名儿童死亡，34名不再有惊厥发作。然而，存活儿童中只有20名被认为正常，14名有严重智力障碍，6名有中度智力障碍，1名有轻度智力障碍。
新生儿H-I是新生儿期癫痫发作的主要原因，死亡率高且有严重的神经系统后遗症。惊厥通常能被经典抗癫痫药物很好地控制，并且与阿氏评分以及孕期和胎盘变化一起，是一个很好的指标。惊厥发作期间脑电图正常应使我们怀疑细微惊厥的真实性，良好的治疗反应或许能证实这一点。
