Overview of evaluation for neonatal seizures

EEG: electroencephalography; MRI: magnetic resonance imaging; MRA: magnetic resonance angiography; MRV: magnetic resonance venography; HIE: hypoxic-ischemic encephalopathy; CNS: central nervous system; ASM: antiseizure medication; TORCH: toxoplasmosis, others (syphilis, Zika virus, varicella-zoster virus), rubella, cytomegalovirus, herpes simplex virus; SeLNE: self-limited (familial) neonatal epilepsy ("fifth-day fits"); SeLFNIE: self-limited familial neonatal-infantile epilepsy; EIDEE: early infantile developmental and epileptic encephalopathy; KCNQ2-DEE: KCNQ2 developmental and epileptic encephalopathy; PD-DEE: pyridoxine-dependent developmental and epileptic encephalopathy; P5PD-DEE: pyridoxamine 5'-phosphate deficiency developmental and epileptic encephalopathy.

* Term newborns presenting with neonatal encephalopathy may require immediate resuscitation and should be triaged as quickly as possible to determine eligibility for therapeutic hypothermia, which must be started within 6 hours of birth and maintained for 72 hours. Refer to UpToDate topics on neonatal encephalopathy.

¶ Refer to UpToDate topics on neonatal seizures for details.

Δ Electrographic-only (ie, subclinical) seizures occur without clinical manifestations and are very common in the neonate. These seizures have similar pathogenesis and similar prognostic and treatment implications compared with electroclinical seizures.

◊ MRA should be obtained if arterial ischemic stroke or vascular malformation are suspected. MRV should be obtained if venous sinus thrombosis is suspected.

§ Some neonates with epilepsy also have acute provoking factors, such as HIE or infection, that predispose to neonatal seizures; all neonates with seizures require a full evaluation for treatable causes.