Seizures CLINICAL PEARLS AND PITFALLS Clinical seizures in the neonate are very subtle due to incomplete myelination of the motor pathways; infants can present with tongue thrusting, lip smacking, bicycling, or intermittent repetitive motions of a single extremity or trunk; generalized clonic–tonic movements are unlikely manifestations Neonatal seizures can be due to hypoglycemia and/or electrolyte abnormalities, particularly from incorrect formula preparation Neonatal seizures may benefit from pyridoxine Current Evidence Because of rapid, continued development of the neonatal brain, both clinical and electroencephalographic (EEG) seizures of the newborn, vary dramatically from the older child, so that recognizing the seizing infant remains a major challenge to clinicians Therefore, the true incidence of neonatal seizures remains unclear, with reported ranges between 0.5% in term infants and 22% in preterm infants The effect of neonatal seizures on outcome is largely influenced by the underlying disease process However, regardless of etiology, it is believed that seizures in the neonate can disrupt normal biochemical pathways responsible for the development and maturation of the CNS Prolonged neonatal seizures can lower the seizure threshold in later life and are associated with learning and memory impairments in adults with seizure disorders Complicating outcome studies of neonatal seizures is that many antiepileptic medications may contribute to medication-induced brain injury and/or teratogenic effects on the brain development, particularly with prolonged use Goals of Treatment The primary goal of treatment is early recognition of neonatal seizures, identification of the etiology, and control of the seizure as quickly as possible True seizure activity should be distinguished from more benign, nonepileptic behaviors of newborns, such as tremors, jitteriness, or benign sleep myoclonus If the seizure is due to hypoglycemia or electrolyte anomalies, initial treatment should be correction of the underlying metabolic abnormality If antiepileptic medications are used to treat seizures, it is important to also initiate EEG