Ramantani Georgia, Schmitt Bernhard, Plecko Barbara, Pressler Ronit M, Wohlrab Gabriele, Klebermass-Schrehof Katrin, Hagmann Cornelia, Pisani Francesco, Boylan Geraldine B
Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland.
Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria.
Neuropediatrics. 2019 Oct;50(5):280-293. doi: 10.1055/s-0039-1693149. Epub 2019 Jul 24.
Neonatal seizures are the most prevalent and distinctive sign of neurologic dysfunction in early life and pose an immense challenge for clinicians. Improvements in neonatal care have increased the survival rate of extremely premature infants, considerably changing the spectrum of underlying etiologies, and instigating a gradual shift from mortality to morbidity. Recognizing neonatal seizures can be challenging due to variability in presentation but clinical features can often provide valuable clues about etiology. Yet, the majority of neonatal seizures are subclinical. Even though conventional electroencephalography (EEG) with simultaneous video detection of seizures still represents the diagnostic gold standard, continuous monitoring using a one- to two-channel amplitude-integrated EEG with concurrent unprocessed EEG can be crucial for early recognition and intervention. Furthermore, tremendous progress has been made in neuroimaging, and all infants with seizures should have a magnetic resonance imaging (MRI) to help identify the underlying etiology. While the majority of neonatal seizures are caused by hypoxic-ischemic events, stroke, hemorrhage, or infection, approximately 15% of patients will require more sophisticated algorithms for diagnostic workup, including metabolic and genetic screening. These recent developments have led to renew interest in the classification of neonatal seizures, which aim to help identify etiology and guide appropriate therapeutic and prognostic decisions. In this review, we outline recent progress made in the etiology, diagnosis, and treatment of neonatal seizures and highlight areas that deserve further research.
新生儿惊厥是生命早期最常见且独特的神经功能障碍体征，给临床医生带来了巨大挑战。新生儿护理的改善提高了极早产儿的存活率，极大地改变了潜在病因的范围，并促使从死亡率逐渐转向发病率。由于临床表现的变异性，识别新生儿惊厥具有挑战性，但临床特征通常可以提供有关病因的宝贵线索。然而，大多数新生儿惊厥是亚临床的。尽管常规脑电图（EEG）结合同步视频检测惊厥仍是诊断金标准，但使用一到两个通道的振幅整合脑电图并同时记录未处理的脑电图进行连续监测对于早期识别和干预至关重要。此外，神经影像学取得了巨大进展，所有惊厥婴儿都应进行磁共振成像（MRI）以帮助确定潜在病因。虽然大多数新生儿惊厥由缺氧缺血事件、中风、出血或感染引起，但约15%的患者需要更复杂的诊断检查算法，包括代谢和基因筛查。这些最新进展引发了对新生儿惊厥分类的新兴趣，其目的是帮助识别病因并指导适当的治疗和预后决策。在本综述中，我们概述了新生儿惊厥在病因、诊断和治疗方面的最新进展，并强调了值得进一步研究的领域。
