page_title: Neonatal seizure
section_title: Diagnosis
hierarchical_section_title: Neonatal seizure / Diagnosis
caption_attribution_description: A normal CFM (aEEG) trace in a term infant who is just a few days old
context_page_description: A neonatal seizure is a seizure in a baby younger than 4 weeks old. Seizures are abnormally excessive or synchronous neuronal activity in the brain. They are the most frequent neurological problem in the nursery, and often require evaluation and treatment in a neonatal intensive care unit. Seizures in the neonatal population can be categorized into acute symptomatic seizures and genetic or structural causes. Diagnosis relies on identification of the cause of the seizure, and verification of an actual seizure activity by measuring of electrical activity with electroencephalography. Treatment depends on the cause of the seizure, but often includes pharmacologic treatment with anti-epileptic drugs.
  Considerable debate about the longterm consequence of a neonatal seizure exists between data and deductions reached through animal experimentations and those obtained through clinical investigations. The main conflicting issues are whether seizures in newborns can plant the roots for epileptogenesis and cause long-term deficits. Fewer than half of the affected infants develop seizures in later life.
context_section_description: Seizure activity in a neonate is difficult to diagnose, as many seizures have no clinical correlate. Altered level of consciousness is often the only clue, and in a neonate this can be difficult to accurately assess. Thus, diagnosis relies on attempting to directly measurement the abnormal electrical activity in the brain with electroencephalography (EEG). EEG is combined with video recording of the infant to correlate any seizure movements with EEG recordings.
  There are several modes of EEG that are commonly used in the NICU to diagnose neonatal seizures. Conventional continuous multichannel conventional EEG is the gold standard for diagnosis of epileptiform activity, but requires expert interpretation. Newer amplitude integrated EEG (aEEG) (also termed cerebral function monitoring, or CFM) allows easier monitoring of brain activity, but may not allow identification of short duration, low amplitude, or very high frequency seizure activity. Often, both modes are displayed concurrently.
caption: A normal amplitude integrated EEG trace in a term infant who is several days old. The amplitude-integrated trace is in the top half of the screen displaying left- and right-sided traces. There is a normal baseline and upper limit, sleep-wake cycling, and no seizures.
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