Plouin Perrine, Kaminska Anna
Hôpital Necker-Enfants Malades, Paris, France.
Handb Clin Neurol. 2013;111:467-76. doi: 10.1016/B978-0-444-52891-9.00051-8.
Epileptic seizures are more frequent in the neonate than at any other time. The incidence of neonatal seizures (NNS) is estimated to be between 1.5 and 5.5/1000 living births, its onset being during the first week in 80% of cases. Mortality rate remains very high (20-45%). Not all paroxysmal manifestations are epileptic, and differential diagnosis remains an important challenge. Neonates may present with different types of seizures: clonic, tonic, myoclonic (axial, focal, erratic), epileptic spasms, and subtle seizures, including autonomic signs or automatisms. The main etiology is hypoxic-ischemic encephalopathy (40-45%) with a very early onset, and variable semiology including all seizure types. An EEG is necessary to recognize the seizures, and interictal tracing may help in assessing prognosis. Ischemic stroke is associated with seizures of early onset, being focal or unilateral. Interictal EEG is asymmetrical, with focal or unilateral patterns. Other etiologies less often linked to epileptic seizures must be looked for such as brain infection, metabolic disorders, chromosomal abnormalities, inborn errors of metabolism, brain malformations, and vitamin B6 dependency. Neonatal epilepsy syndromes may have favorable (benign familial neonatal seizures) or poor (early infantile encephalopathy with epilepsy, early myoclonic encephalopathy, and migrating partial seizures in infancy) prognosis.
癫痫发作在新生儿期比其他任何时期都更频繁。新生儿惊厥（NNS）的发病率估计为每1000例活产中有1.5至5.5例，80%的病例在出生后第一周内发病。死亡率仍然很高（20%-45%）。并非所有的阵发性表现都是癫痫性的，鉴别诊断仍然是一项重要挑战。新生儿可能出现不同类型的惊厥：阵挛性、强直性、肌阵挛性（轴性、局灶性、不规则性）、癫痫性痉挛以及轻微惊厥，包括自主神经症状或自动症。主要病因是缺氧缺血性脑病（40%-45%），起病非常早，症状学多样，包括所有惊厥类型。脑电图对于识别惊厥是必要的，发作间期的脑电图追踪可能有助于评估预后。缺血性中风与早发性惊厥有关，可为局灶性或单侧性。发作间期脑电图不对称，有局灶性或单侧性模式。还必须寻找其他较少与癫痫发作相关的病因，如脑部感染、代谢紊乱、染色体异常、先天性代谢缺陷、脑畸形以及维生素B6依赖症。新生儿癫痫综合征的预后可能良好（良性家族性新生儿惊厥）或不良（早发性婴儿脑病伴癫痫、早期肌阵挛性脑病以及婴儿期游走性部分性惊厥）。
