Download PDF
CC BY-NC-ND 4.0 · International Journal of Epilepsy 2018; 05(01): 002-008
DOI: 10.1055/s-0038-1667213
Review Article
Indian Epilepsy Society

Status Epilepticus in Neonates

Arushi Gahlot Saini
1   Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Kollencheri Puthenveettil Vinayan
2   Division of Pediatric Neurology, Department of Neurology, Amrita Institute of Medical Sciences, Amrita University, Cochin, Kerala, India
› Author Affiliations Funding None.
Further Information

Publication History

Publication Date:
21 July 2018 (online)

   Permissions and Reprints

Abstract

Seizures are a reflection of acute brain injury in the neonatal period, and status epilepticus reflects a state of high seizure burden. Neonatal status epilepticus has been reported in 8 to 43% of newborns with seizures. There is no separate definition for neonatal status epilepticus, and it has been commonly defined as a continuous seizure lasting at least 30 minutes and/or a series of seizures whose total duration exceeds 50% of a given epoch. The causes of status epilepticus in the neonatal period mirror the causes of neonatal seizures. It is symptomatic, usually associated with hypoxic–ischemic encephalopathy, inherited metabolic disorders, infections, and cerebral hemorrhage. Management guidelines are not separately outlined for neonatal status epilepticus and are commonly derived from the recommendations for neonatal and infantile seizures. The presence of neonatal status epilepticus significantly increases the odds for development of cerebral palsy, global developmental delay, and epilepsy later in life. Further research is needed into the role of current antiepileptic drugs in causing neuronal injury and use of neuroprotective agents during neonatal status epilepticus.

Keywords

neonatal seizures - neonatal status epilepticus - status epilepticus - antiepileptic - brain injury
 

  • References

  • 1 Volpe J. Neonatal seizures. In: Neurology of the Newborn. Philadelphia, PA: W.B. Saunders; 2001: 178-214
    Google Scholar
  • 2 Pisani F, Cerminara C, Fusco C, Sisti L. Neonatal status epilepticus vs recurrent neonatal seizures: clinical findings and outcome. Neurology 2007; 69 (23) 2177-2185
    CrossrefPubMedGoogle Scholar
  • 3 Jonas P, Racca C, Sakmann B, Seeburg PH, Monyer H. Differences in Ca2+ permeability of AMPA-type glutamate receptor channels in neocortical neurons caused by differential GluR-B subunit expression. Neuron 1994; 12 (06) 1281-1289
    CrossrefPubMedGoogle Scholar
  • 4 Zhong J, Carrozza DP, Williams K, Pritchett DB, Molinoff PB. Expression of mRNAs encoding subunits of the NMDA receptor in developing rat brain. J Neurochem 1995; 64 (02) 531-539
    PubMedGoogle Scholar
  • 5 Dunning DD, Hoover CL, Soltesz I, Smith MA, O'Dowd DK. GABA(A) receptor-mediated miniature postsynaptic currents and alpha-subunit expression in developing cortical neurons. J Neurophysiol 1999; 82 (06) 3286-3297
    CrossrefPubMedGoogle Scholar
  • 6 Khazipov R, Khalilov I, Tyzio R, Morozova E, Ben-Ari Y, Holmes GL. Developmental changes in GABAergic actions and seizure susceptibility in the rat hippocampus. Eur J Neurosci 2004; 19 (03) 590-600
    CrossrefPubMedGoogle Scholar
  • 7 Dzhala VI, Talos DM, Sdrulla DA. et al. NKCC1 transporter facilitates seizures in the developing brain. Nat Med 2005; 11 (11) 1205-1213
    CrossrefPubMedGoogle Scholar
  • 8 Mikati MA, Werner S, Shalak L. et al. Stages of status epilepticus in the developing brain. Epilepsy Res 2003; 55 (01) (02) 9-19
    CrossrefPubMedGoogle Scholar
  • 9 Berg AT, Shinnar S, Levy SR, Testa FM. Status epilepticus in children with newly diagnosed epilepsy. Ann Neurol 1999; 45 (05) 618-623
    CrossrefPubMedGoogle Scholar
  • 10 Lowenstein DH. Status epilepticus: an overview of the clinical problem. Epilepsia 1999; 40 (Suppl. 01) S3-S8 discussion S21–S22
    PubMedGoogle Scholar
  • 11 Trinka E, Cock H, Hesdorffer D. et al. A definition and classification of status epilepticus—report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56 (10) 1515-1523
    CrossrefPubMedGoogle Scholar
  • 12 Smith DM, McGinnis EL, Walleigh DJ, Abend NS. Management of status epilepticus in children. J Clin Med 2016; 5 (04) 5
    CrossrefPubMedGoogle Scholar
  • 13 Berg AT, Berkovic SF, Brodie MJ. et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010; 51 (04) 676-685
    CrossrefPubMedGoogle Scholar
  • 14 Mizrahi EM. Acute and chronic effects of seizures in the developing brain: lessons from clinical experience. Epilepsia 1999; 40 (Suppl. 01) S42-S50 discussion S64–S66
    CrossrefPubMedGoogle Scholar
  • 15 Prasad AN, Seshia SS. Status epilepticus in pediatric practice: neonate to adolescent. Adv Neurol 2006; 97: 229-243
    PubMedGoogle Scholar
  • 16 Wusthoff CJ, Dlugos DJ, Gutierrez-Colina A. et al. Electrographic seizures during therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy. J Child Neurol 2011; 26 (06) 724-728
    CrossrefPubMedGoogle Scholar
  • 17 Pisani F, Orsini M, Braibanti S, Copioli C, Sisti L, Turco EC. Development of epilepsy in newborns with moderate hypoxic-ischemic encephalopathy and neonatal seizures. Brain Dev 2009; 31 (01) 64-68
    CrossrefPubMedGoogle Scholar
  • 18 Wertheim D, Mercuri E, Faundez JC, Rutherford M, Acolet D, Dubowitz L. Prognostic value of continuous electroencephalographic recording in full term infants with hypoxic ischaemic encephalopathy. Arch Dis Child 1994; 71 (02) F97-F102
    CrossrefPubMedGoogle Scholar
  • 19 McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neurodevelopmental outcome. Neurology 2000; 55 (04) 506-513
    CrossrefPubMedGoogle Scholar
  • 20 Pavlidis E, Spagnoli C, Pelosi A, Mazzotta S, Pisani F. Neonatal status epilepticus: differences between preterm and term newborns. Eur J Paediatr Neurol 2015; 19 (03) 314-319
    CrossrefPubMedGoogle Scholar
  • 21 Lawrence R, Inder T. Neonatal status epilepticus. Semin Pediatr Neurol 2010; 17 (03) 163-168
    CrossrefPubMedGoogle Scholar
  • 22 Shellhaas RA, Clancy RR. Characterization of neonatal seizures by conventional EEG and single-channel EEG. Clin Neurophysiol 2007; 118 (10) 2156-2161
    CrossrefPubMedGoogle Scholar
  • 23 Lawrence R, Mathur A, Nguyen The TichS, Zempel J, Inder T. A pilot study of continuous limited-channel aEEG in term infants with encephalopathy. J Pediatr 2009; 154 (06) 835-41.e1
    CrossrefPubMedGoogle Scholar
  • 24 Silverstein FS, Jensen FE. Neonatal seizures. Ann Neurol 2007; 62 (02) 112-120
    CrossrefPubMedGoogle Scholar
  • 25 Wusthoff CJ. Diagnosing neonatal seizures and status epilepticus. J Clin Neurophysiol 2013; 30 (02) 115-121
    CrossrefPubMedGoogle Scholar
  • 26 Lombroso CT. Neonatal seizures: gaps between the laboratory and the clinic. Epilepsia 2007; 48 (Suppl. 02) 83-106
    CrossrefPubMedGoogle Scholar
  • 27 Vasudevan C, Levene M. Epidemiology and aetiology of neonatal seizures. Semin Fetal Neonatal Med 2013; 18 (04) 185-191
    CrossrefPubMedGoogle Scholar
  • 28 Vinayan KP, Moshe SL. Neonatal seizures and epilepsies. Int J Epilep 2014; 1: 75-83
    PubMedGoogle Scholar
  • 29 Dlugos DJ. The nature of neonatal status epilepticus—a clinician's perspective. Epilepsy Behav 2015; 49: 88-89
    CrossrefPubMedGoogle Scholar
  • 30 Hart AR, Pilling EL, Alix JJ. Neonatal seizures-part 1: not everything that jerks, stiffens and shakes is a fit. Arch Dis Child Educ Pract Ed 2015; 100 (04) 170-175
    CrossrefPubMedGoogle Scholar
  • 31 Saini AG, Taketani T, Sahu JK, Singhi P. Startles, stiffness, and SLC6A5: do you know the condition?. Pediatr Neurol 2018; 81: 49-50
    CrossrefPubMedGoogle Scholar
  • 32 Abend NS, Wusthoff CJ, Goldberg EM, Dlugos DJ. Electrographic seizures and status epilepticus in critically ill children and neonates with encephalopathy. Lancet Neurol 2013; 12 (12) 1170-1179
    CrossrefPubMedGoogle Scholar
  • 33 Silverstein FS, Jensen FE, Inder T, Hellstrom-Westas L, Hirtz D, Ferriero DM. Improving the treatment of neonatal seizures: National Institute of Neurological Disorders and Stroke workshop report. J Pediatr 2008; 153 (01) 12-15
    CrossrefPubMedGoogle Scholar
  • 34 Clancy RR. Summary proceedings from the neurology group on neonatal seizures. Pediatrics 2006; 117 (03) Pt 2 S23-S27
    PubMedGoogle Scholar
  • 35 Shellhaas RA, Chang T, Tsuchida T. et al. The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol 2011; 28 (06) 611-617
    CrossrefPubMedGoogle Scholar
  • 36 Sankar R, Shin DH, Liu H, Mazarati A, Pereira de VasconcelosA, Wasterlain CG. Patterns of status epilepticus-induced neuronal injury during development and long-term consequences. J Neurosci 1998; 18 (20) 8382-8393
    CrossrefPubMedGoogle Scholar
  • 37 Shah DK, Wusthoff CJ, Clarke P. et al. Electrographic seizures are associated with brain injury in newborns undergoing therapeutic hypothermia. Arch Dis Child Fetal Neonatal Ed 2014; 99 (03) F219-F224
    CrossrefPubMedGoogle Scholar
  • 38 Painter MJ, Scher MS, Stein AD. et al. Phenobarbital compared with phenytoin for the treatment of neonatal seizures. N Engl J Med 1999; 341 (07) 485-489
    CrossrefPubMedGoogle Scholar
  • 39 Hellström-Westas L, Boylan G, Ågren J. Systematic review of neonatal seizure management strategies provides guidance on anti-epileptic treatment. Acta Paediatr 2015; 104 (02) 123-129
    CrossrefPubMedGoogle Scholar
  • 40 Glass HC, Kan J, Bonifacio SL, Ferriero DM. Neonatal seizures: treatment practices among term and preterm infants. Pediatr Neurol 2012; 46 (02) 111-115
    CrossrefPubMedGoogle Scholar
  • 41 Gospe Jr SM. Neonatal vitamin-responsive epileptic encephalopathies. Chang Gung Med J 2010; 33 (01) 1-12
    PubMedGoogle Scholar
  • 42 Krief P, Li Kan, Maytal J. Efficacy of levetiracetam in children with epilepsy younger than 2 years of age. J Child Neurol 2008; 23 (05) 582-584
    CrossrefPubMedGoogle Scholar
  • 43 Khan O, Chang E, Cipriani C, Wright C, Crisp E, Kirmani B. Use of intravenous levetiracetam for management of acute seizures in neonates. Pediatr Neurol 2011; 44 (04) 265-269
    CrossrefPubMedGoogle Scholar
  • 44 Talos DM, Chang M, Kosaras B. et al. Antiepileptic effects of levetiracetam in a rodent neonatal seizure model. Pediatr Res 2013; 73 (01) 24-30
    CrossrefPubMedGoogle Scholar
  • 45 Jensen FE. Neonatal seizures: an update on mechanisms and management. Clin Perinatol 2009; 36 (04) 881-900 vii
    CrossrefPubMedGoogle Scholar
  • 46 Srinivasakumar P, Zempel J, Wallendorf M, Lawrence R, Inder T, Mathur A. Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: electrographic seizures and magnetic resonance imaging evidence of injury. J Pediatr 2013; 163 (02) 465-470
    CrossrefPubMedGoogle Scholar
  • 47 Pressler RM, Boylan GB, Marlow N. et al NEonatal seizure treatment with Medication Off-patent (NEMO) consortium. Bumetanide for the treatment of seizures in newborn babies with hypoxic ischaemic encephalopathy (NEMO): an open-label, dose finding, and feasibility phase 1/2 trial. Lancet Neurol 2015; 14 (05) 469-477
    CrossrefPubMedGoogle Scholar
  • 48 Harris ML, Malloy KM, Lawson SN, Rose RS, Buss WF, Mietzsch U. Standardized treatment of neonatal status epilepticus improves outcome. J Child Neurol 2016; 31 (14) 1546-1554
    CrossrefPubMedGoogle Scholar
  • 49 Akman O, Moshé SL, Galanopoulou AS. Early life status epilepticus and stress have distinct and sex-specific effects on learning, subsequent seizure outcomes, including anticonvulsant response to phenobarbital. CNS Neurosci Ther 2015; 21 (02) 181-192
    CrossrefPubMedGoogle Scholar
  • 50 Raspall-Chaure M, Chin RF, Neville BG, Scott RC. Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol 2006; 5 (09) 769-779
    CrossrefPubMedGoogle Scholar
  • 51 Dunleavy M, Shinoda S, Schindler C. et al. Experimental neonatal status epilepticus and the development of temporal lobe epilepsy with unilateral hippocampal sclerosis. Am J Pathol 2010; 176 (01) 330-342
    CrossrefPubMedGoogle Scholar
  • 52 Yıldız EP, Tatlı B, Ekici B. et al. Evaluation of etiologic and prognostic factors in neonatal convulsions. Pediatr Neurol 2012; 47 (03) 186-192
    CrossrefPubMedGoogle Scholar
  • 53 Shinnar S, Pellock JM, Berg AT. et al. Short-term outcomes of children with febrile status epilepticus. Epilepsia 2001; 42 (01) 47-53
    PubMedGoogle Scholar