Definition:

Seizure is defined as a paroxysmal episode of neurological dysfunction due to excessive and hyper synchronous discharge of cerebral neurons manifested as motor, sensory, autonomic or psychiatric phenomenon.

Classification:

Seizures can be classified as-
1. Subtle seizure
2. Tonic seizure
3. Clonic seizure
4. Myoclonic seizure

Investigations:

In case of neonatal seizure following investigations are done to find out the underlying cause(s)-

1. TC, DC, Hb%, ESR
2. Random blood glucose
3. Serum electrolytes
4. Serum Ca++, Mg++
5. Serum bilirubin (if clinically jaundiced)
6. CSF study
7. USG of the brain
8. Screening for TORCH infection
9. EEG
10. CT scan of the brain

Management of Neonatal seizure:

Immediate management –

1. Establishment of breathing and maintenance of circulation.
2. Oxygen inhalation (Ventilation perfusion- if needed)
3. IV infusion according to body weight & age
4. Inj. Phenobarbitone 20 mg/kg body weight IV slowly over 20 minutes
5. If neonatal seizure is not controlled Inj. Phenobarbitone is repeated at a dose of 10 mg/kg body weight IV at 20 -30 minutes interval for additional 2 doses.
6. If seizure is not yet controlled Inj. Phenytoin is given after dilution with normal saline at a dose of 20 mg/kg body weight slowly over 20 minutes.
7. If seizure is not yet controlled Inj. Phenytoin is repeated at a dose of 10 mg/kg IV
8. Inj. Midazolam IV is used if seizure is not yet controlled.
9. At the same time investigations are done to exclude Hypoxia induced encephalopathy (HIE), hypoglycemia, electrolyte imbalance, hypocalcaemia, hypomagnesaemia, infection, kernicterus etc.
10. Treatment of underlying cause(s) if present.
11. If seizure still persists following causes should be excluded- TORCH infection, structural abnormality of the brain, Inborn errors of metabolism.

Maintenance of anticonvulsant therapy-

For maintenance therapy Inj. Phenobarbitone is used at a dose of 3-5 mg/kg per day. If needed Inj. Phenytoin is also used for maintenance at a dose of 3-5 mg/kg per day. The maintenance dose is started 12 hours after administration of loading dose in 12 hourly divided doses IV or orally.