Epilepsy in newborns. What to do?

How does epilepsy manifest in newborns and what are its causes? Is this disease treated in infants and what should parents do?

Newborns have the highest number of seizures among all young patients with epilepsy, which is due to numerous reasons. In premature babies under 1500 grams, seizures are most common.

As found in a 1995 study of neonatal seizures by Kentucky neurologists, two out of three newborns with epilepsy develop seizures in the first 2 days of life. In many newborns, seizures stop after a short period of time and do not accompany the child for life.

Causes of epileptic seizures in newborns

There are many causes of epilepsy in newborns. There are the following reasons:

• Classical epileptic encephalopathies

Otahara syndrome and early myoclonic encephalopathy (RME).

Early myoclonic encephalopathy (RME).

Epileptic seizures begin in the first 3 months of a baby’s life, but, in most cases, appear for the first time within the first 30 days. With RME in children, combinations of two epileptic seizures are recorded: tonic and myoclonic , but myoclonic occurs most often .

When conducting an EEG, the same epileptic activity is manifested, as in the case of Otahara syndrome . In most cases, the cause of the disease is metabolic genetic diseases. Unfortunately, the syndrome has a poor prognosis with a high mortality rate and mental retardation.

Epilepsy of infancy with migratory seizures. 

Attacks begin in newborns a few days after birth or up to 2 months. The syndrome is characterized by focal (focal) tonic or clonic seizures. This syndrome is associated with 7 genetic mutations. The prognosis in children with this syndrome is not favorable, since drug treatment does not give results, and the disease itself is accompanied by a developmental delay.

• benign genetic diseases

Benign familial neonatal seizures. This diagnosis can be established in the case when the patient’s family history recorded epileptic seizures at an early age in relatives. The disease, in most cases, manifests itself between 2 days and 3 months of a baby’s life. Attacks in this case are accompanied by tachycardia with or without respiratory arrest. In the continuation of life, clonic movements appear, which can be symmetrical or occur on separate parts of the body. In this case, the side on which the attack occurs may change.

There are 3 genetic mutations associated with this syndrome. In most cases, benign familial neonatal seizures respond well to treatment and resolve before the baby is 8 months old. However, children have a chance of developing epileptic activity in the future.

Benign non-familial neonatal seizures or fifth-day seizures. Attacks begin in newborns in the first week of life. In 90% of children, they begin between the fourth and sixth days. That is why they are called day 5 cramps.

The disease resolves up to 8 months, and the attacks are in fact always asymmetrically clonic, which can appear on one side with generalization and last for 1-3 minutes. In general, seizures are frequent and repetitive, with the manifestation of status epilepticus. The syndrome is caused by a genetic mutation in KCNQ2.

In newborns with convulsions of the fifth day, the prognosis for the development of the disease is favorable, since it passes on its own. Some of the children during the first year of life may experience a developmental delay, but they will catch up with their peers after a while and this will not leave a negative mark on their lives.

• Malignant genetic diseases

We are talking about epileptic encephalopathies with developmental delay, which occur against the background of genetic mutations.

In the absence of a clear cause of the disease on MRI of the brain, recorded problems at birth and primary metabolic studies, genetic tests should be performed to help determine a more accurate diagnosis and prescribe appropriate treatment.

• metabolic diseases

Numerous metabolic diseases can lead to neonatal epilepsy and neonatal seizures. Despite the numerous number of these diseases, they are extremely rare.

• Epileptic seizures caused by various injuries

Brain damage in newborns can occur in case of hypoxia during childbirth, electrolyte disorders (hypoglycemia, hypocalcemia , hypomagnesemia ), infectious diseases involving the nervous system, etc.

• Cerebrovascular disorders

During these disorders, pathological changes in the cerebral vessels occur in the brain, as a result of which blood circulation is disturbed.

• withdrawal syndrome

This syndrome occurs if the mother used drugs during pregnancy.

Consequences of neonatal seizures in newborns

Approximately one third of newborns with neonatal seizures suffer some kind of neurological disorder later in life. A relationship has also been established between the intensity of neonatal seizures and between neurological disorders.

Is there a cure for epilepsy in infants?

Usually, neonatal seizures in newborns resolve after a short time, as a result of which drug treatment can be stopped in most children. Although the seizures may go away, treatment is still required.

If the causes of neonatal seizures are metabolic disorders, it is necessary, first of all, to treat the cause of the disease, i.e. normalize sugar, calcium, magnesium or B vitamins.

The two most commonly used drugs for neonatal seizures, which can be given intravenously to quickly reach effective blood levels of the drug, are phenobarbital and phenytoin. If these drugs do not help stop the seizures, midazolam , lidocaine, or levetiracetam , and then other antiepileptic drugs, may be tried.