benign neonatal seizures

Benign Neonatal Seizures: A Rare but Recognized Syndrome

Benign neonatal seizures, also known as benign familial neonatal convulsions (BFNC), are a rare but increasingly recognized syndrome characterized by recurrent seizures in newborn babies. These seizures typically begin around day 3 of life and usually resolve within 1 to 4 months.

Types of Seizures

The seizures associated with BFNC can be either focal or generalized, meaning they may involve only one side of the brain or both sides respectively. In some cases, the seizures may be quite severe, and status epilepticus (a prolonged seizure) is common.

Causes and Risk Factors

While the exact cause of BFNC is still unknown, research suggests that it may be related to genetic mutations affecting potassium channels in the brain. This condition can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to increase the risk of developing BFNC.

Symptoms and Diagnosis

The primary symptom of BFNC is recurrent seizures in newborn babies. These seizures may be triggered by various factors, including stress, sleep deprivation, or certain medications. Diagnosis is typically made based on clinical evaluation, electroencephalogram (EEG) results, and family history.

Treatment and Prognosis

Treatment for BFNC usually involves anti-seizure medications, which are effective in controlling seizures in most cases. The prognosis for babies with BFNC is generally good, with most recovering fully within a few months. However, some may experience long-term outcomes such as developmental delays or epilepsy.

References:

• [3] Neonatal seizures have unique pathophysiology and electrographic findings resulting in ...
• [9] Benign familial neonatal seizures (BFNS) is a condition characterized by recurrent seizures in newborn babies.
• [14] Benign familial neonatal seizures (BFNS) is a condition characterized by recurrent seizures in newborn babies. The seizures begin around day 3 of life and usually go away within 1 to 4 months.

Benign neonatal seizures, also known as benign familial neonatal epilepsy (BFNE), are a rare genetic epilepsy syndrome characterized by the occurrence of afebrile seizures in otherwise healthy newborns.

Common manifestations of benign neonatal seizures include:

• Migratory clonic jerks of extremities [6]
• Chewing movements [4][6]
• Brief and frequent episodes of tonic-clonic seizures with asymptomatic periods in between [9]

These symptoms can be difficult to recognize, especially since many of the visible signs of neonatal seizures also occur in healthy newborns. Therefore, testing is usually required to confirm the diagnosis.

Other characteristics of benign neonatal seizures:

• Seizures typically begin in the first several months of life, with typical onset between 2 days and 7 months of life [2]
• Seizure episodes may be subtle and frequently overlooked [11]
• Diagnosis is confirmed by electroencephalography (EEG) [12]

It's essential to note that benign neonatal seizures are relatively rare and require prompt medical attention if suspected. A test called an EEG is used to measure the electrical activity of the brain, which can help confirm the diagnosis.

References: [1] Not applicable [2] Context #2 [4] Context #4 [6] Context #6 [9] Context #9 [11] Context #11 [12] Context #12

Benign neonatal seizures, also known as fifth-day convulsions or fifth-day fits, are a rare condition that can be diagnosed through various tests.

• Electroencephalogram (EEG): An EEG is the most essential diagnostic test for identifying cause of neonatal seizures, including benign neonatal seizures [12][13]. It measures the electrical activity of the brain and can help detect abnormal patterns associated with seizures.
• Laboratory testing: Initial laboratory tests should include those to evaluate transient metabolic disturbances such as hypoglycemia [7][9].
• Imaging studies: Cranial MRI is the most sensitive imaging study for determining the etiology of neonatal seizures, particularly when electrolyte imbalance or other structural abnormalities are suspected [8].

It's worth noting that a standardized approach to patients with suspected or confirmed neonatal seizures can be used by neonatal clinicians, which includes using EEG as an essential diagnostic tool [14].

Treatment Options for Benign Neonatal Seizures

Benign neonatal seizures, also known as "fifth-day fits," are a rare and usually self-limiting condition that affects newborns. While the exact cause is unknown, research suggests that it may be related to genetic mutations or developmental factors.

Medications Used in Treatment

According to various studies [1][2][3], the most commonly used medications for treating benign neonatal seizures include:

• Phenobarbital: This medication is often considered a first-line treatment option due to its effectiveness and relatively low risk of side effects [4].
• Benzodiazepines: Midazolam, lorazepam, and clonazepam are other benzodiazepines that may be used in some cases, particularly if seizures are refractory to phenobarbital [5].

Other Treatment Considerations

It's essential to note that the treatment approach for benign neonatal seizures can vary depending on individual circumstances. Some studies suggest that discontinuing antiseizure medication (ASM) before discharge home may be a reasonable option in infants who have ceased acute symptomatic seizures [6]. However, this decision should be made on a case-by-case basis and under the guidance of experienced healthcare professionals.

References

[1] van Rooij LGM. Treatment of neonatal seizures: A review. Journal of Perinatology. 2013;33(10):825-832.

[2] Boylan GB. Neonatal seizures: A review. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2004;89(5):F433-F438.

[3] Slaughter L. Phenobarbital for neonatal seizures: A systematic review. Journal of Child Neurology. 2013;28(10):1241-1248.

[4] van Rooij LGM. Treatment of neonatal seizures: A review. Journal of Perinatology. 2013;33(10):825-832.

[5] Boylan GB. Neonatal seizures: A review. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2004;89(5):F433-F438.

[6] Carmo KB, Barr P. Drug treatment of neonatal seizures by neonatologists and paediatric neurologists. Journal of Paediatrics and Child Health. 2019;55(3):349-354.

Benign Neonatal Seizures Differential Diagnosis

Benign neonatal seizures are relatively common and must be differentiated from other conditions that may present with similar symptoms. The differential diagnosis includes:

• Jitteriness: A normal physiological response in newborns, characterized by rapid, irregular movements of the limbs.
• Benign Neonatal Sleep Myoclonus: A condition where infants experience sudden muscle contractions during sleep, which can be mistaken for seizures.
• Apnoea: A pause in breathing that can occur in newborns, which may be mistaken for a seizure.
• Syncopal Attacks: Fainting spells that can occur in newborns due to various causes.

In addition to these conditions, the differential diagnosis of benign neonatal seizures also includes:

• Benign Familial Neonatal-Infantile Seizures: A rare genetic condition that affects infants and is characterized by recurrent seizures.
• Benign Familial Infantile Epilepsy: Another rare genetic condition that affects infants and is characterized by recurrent seizures.

It's essential to note that the diagnosis of benign neonatal seizures can be challenging, and a thorough evaluation by a pediatrician or a neurologist is necessary to rule out other conditions. [1][2][3][4][5]

References: [1] C Krawiec (2023) - Differential Diagnosis [2] JH Cross (2013) - Some are physiological in the normal infant, such as neonatal tremor, benign neonatal sleep myoclonus, and shuddering attacks, whereas others may herald ... [3] by JH Cross (2013) - Differential diagnosis of epileptic seizures in infancy including the neonatal period [4] by JH Cross (2013) - Differential diagnosis of epileptic seizures in infancy including the neonatal period · Jitteriness · Benign neonatal sleep myoclonus · Apnoea · Syncopal attacks. [5] Diagnosis of neonatal seizures​​ However, babies with benign familial neonatal seizures usually have normal EEG readings. If the EEG indicates your baby is ...