neonatal status epilepticus
Introduction
Introduction The status of epilepsy in the neonatal period is a type of status epilepticus. The status of epileptic seizures in the neonatal period is diverse, atypical, mostly mild twitching, and the singular and torsional movements of the limbs often turn from one limb to the other limb or half body twitching, and the apnea is unconscious. EEG visible characteristic abnormalities, 1 ~ 4Hz slow wave inclusion spikes or 2 ~ 6Hz rhythmic spine slow wave synthesis, tonic attack is wave, clonic attacks have spikes, sharp waves. Mainly caused by non-standard anti-epileptic drugs, brain organic diseases, acute metabolic diseases, and their own factors.
Cause
Cause
(1) Non-standard anti-epileptic drug treatment: more common in newly-occurring patients began to standardize drug treatment, suddenly stopped, reduced, not timely or did not follow the doctor's medication, multiple times to miss the drug, stop the drug, use the "prescription" And the random change of the dose or type of the drug, resulting in the inability to achieve an effective blood concentration, so that 21% of children with epilepsy and 34% of adult patients with epilepsy.
(2) brain organic disease: brain trauma, brain tumor, cerebral hemorrhage, cerebral infarction, encephalitis, metabolic encephalopathy, degenerative disease, perinatal injury and drug poisoning patients without epilepsy history with epilepsy as the first symptom accounted for 50 % to 60%, epilepsy in the history of epilepsy accounted for 30% to 40%.
(3) Acute metabolic diseases: Patients with acute metabolic diseases without epileptic seizures accounted for 12% to 41% of the initial symptoms of epileptic seizures, and those with epileptic seizures accounted for 5% of persistent symptoms.
(4) Self-factors: In patients with epilepsy, fever, systemic infection, surgery, high mental stress and excessive fatigue can induce a sustained state even if the effective blood concentration is maintained.
Predisposing factors: fever, infection, fatigue, alcohol consumption, alcohol withdrawal, pregnancy and childbirth, sedatives, and isoniazid, tricyclic or tetracyclic antidepressants can also be induced.
Examine
an examination
Related inspection
Cerebrospinal fluid routine test (CSF) cerebrospinal fluid lactate
The status of epileptic seizures in the neonatal period is diverse, atypical, mostly mild twitching, and the singular and torsional movements of the limbs often turn from one limb to the other limb or half body twitching, and the apnea is unconscious. EEG visible characteristic abnormalities, 1 ~ 4Hz slow wave inclusion spikes or 2 ~ 6Hz rhythmic spine slow wave synthesis, tonic attack is wave, clonic attacks have spikes, sharp waves.
Diagnosis
Differential diagnosis
Neonatal hand and foot movement: It is the sequelae of the clinical manifestation period of neonatal bilirubin encephalopathy (usually occurring 2 months or later after birth). Performance: manifested as hand and foot movement, eye movement disorder, deafness, mental retardation or teeth Enamel dysplasia and so on.
Neonatal convulsions: The movement of various parts of the body is under the control of the brain, and the corresponding muscles are legally reduced and relaxed. When the brain cells function disorder due to some reason, not only can the systemic and local movements be controlled in a coordinated manner, but also the brain cells are abnormally discharged, causing muscle contraction (tonic convulsions) or local muscle contraction (localized convulsions). Sudden loss of consciousness during the attack, head tilted back or turned to one side, the eyeball fixed or upturned, strabismus, foaming at the mouth, facial, hand and foot muscles strong or involuntarily twitching, stopping for a few seconds to a few minutes, and then lethargic. Due to the thinning of the cerebral cortex, the development of the central nervous system is not perfect, and it is more prone to convulsions. Neonatal convulsions are more atypical, often manifested as two-eye gaze, nystagmus, local muscle twitching on the face, or irregular twitching of the limbs. Some are only pale or flushed, sweating, breathing irregularly; or holding your breath, apnea, and purplish skin. Twitching is a serious condition in childhood, especially in newborns. Not only does the manifestation of convulsions confuse parents, but it can also have serious consequences. Why? On the one hand, the causes of neonatal convulsions are often serious diseases, which themselves can be fatal or maiming.
Neonatal tremor: Children with physiological tremors due to imperfect development of the nervous system, this episode does not affect the child's sleep and spirit, tapping or diverting attention will quickly terminate the episode, the child's growth and development It also has no effect and gradually disappears as the nervous system develops. However, there may be some pathological seizure factors, which can be divided into febrile seizures and athermal convulsions according to clinical manifestations, while central nervous system diseases and metabolic abnormalities such as vitamin D deficiency hypocalcemia, hypoglycemia and vitamin B6 deficiency. Waiting for it will cause the child to have a seizure.
The status of epileptic seizures in the neonatal period is diverse, atypical, mostly mild twitching, and the singular and torsional movements of the limbs often turn from one limb to the other limb or half body twitching, and the apnea is unconscious. EEG visible characteristic abnormalities, 1 ~ 4Hz slow wave inclusion spikes or 2 ~ 6Hz rhythmic spine slow wave synthesis, tonic attack is wave, clonic attacks have spikes, sharp waves.
