7 - The baby with a suspected seizure

Summary

Clinical manifestations of neonatal seizure

All those involved in the care of babies need to maintain a high index of suspicion regarding the possibility of seizures. Not only are seizures common in the first few days of life, but they are also difficult to diagnose because the clinical manifestations are varied, subtle, and unlike those seen at other times of life. The diagnosis of seizure should be considered if a baby makes odd repetitive stereotyped movements of the limbs or face. Subtle seizures can manifest as repetitive blinking, chewing, eye-rolling or darting tongue movements. Seizures can also involve a stare without blinking, forced eye deviation, peculiar limb postures, apnea or a fixed smile. Ocular manifestations are common, and eye closure during a suspicious event makes the diagnosis of seizure less likely, although it does not exclude it completely [1]. Myoclonic jerks can be normal in sleep but myoclonic epilepsy does occasionally manifest in the neonatal period. Clinical seizures are often short-lived in babies; typically the baby becomes still, there is a change in breathing pattern (sometimes apnea), and a change in level of alertness followed by subtle repetitive movements involving the face or limbs. The whole episode may be over in less than a minute, but the same pattern does tend to recur, in which case it becomes more suspicious.