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Neonatal seizures are relatively common, but their diagnosis and management remain challenging. We reviewed the scientific literature on neonatal seizures from July 1973 to November 2023. Several parameters were considered, including pathophysiology, diagnostic criteria, electroencephalographic findings and treatment. Recent classification system of seizures and epilepsies in the newborn, as well as treatment recommendations of neonatal seizures, have been proposed. Nonetheless, the approach to neonatal seizures varies among clinicians and centres, including detection, investigation, treatment and follow-up of patients. There are still many issues on the diagnosis and treatment of neonatal seizures, including the meaning or relevance of some electroencephalographic findings, the precise estimation of the seizure burden, the limited efficacy and side effects risk of antiseizure medications, and the best measures to establish the outcome. [ABSTRACT FROM AUTHOR]

For this reason, at 2 months of life, he was admitted to the hospital where physical, neurologic and cardiologic examination, brain ultrasound, standard EEG, blood cell count, serum ferritin level and electrocardiogram (ECG) showed no abnormalities. As the consciousness was regained, the background EEG rapidly returned to normal.[4] We provide an interesting video EEG with polygraphy providing insights on the pathophysiology of BHA. We report the complete video electroencephalogram (vEEG) features of a breath-holding attack event, describing the pathophysiological sequence of events. [Extracted from the article]

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Aim: To identify factors that may predict and affect the risk of relapse in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Method: This was a retrospective study of an Italian cohort of patients with paediatric (≤18y) onset anti-NMDAR encephalitis.Results: Of the 62 children included (39 females; median age at onset 9y 10mo, range 1y 2mo-18y; onset between 2005 and 2018), 21 per cent relapsed (median two total events per relapsing patient, range 2-4). Time to first relapse was median 31.5 months (range 7-89mo). Severity at first relapse was lower than onset (median modified Rankin Scale [mRS] 3, range 2-4, vs median mRS 5, range 3-5; admission to intensive care unit: 0/10 vs 3/10). At the survival analysis, the risk of relapsing was significantly lower in patients who received three or more different immune therapies at first disease event (hazard ratio 0.208, 95% confidence interval 0.046-0.941; p=0.042). Neurological outcome at follow-up did not differ significantly between patients with relapsing and monophasic disease (mRS 0-1 in 39/49 vs 12/13; p=0.431), although follow-up duration was significantly longer in relapsing (median 84mo, range 14-137mo) than in monophasic patients (median 32mo, range 4-108mo; p=0.002).Interpretation: Relapses may occur in about one-fifth of children with anti-NMDAR encephalitis, are generally milder than at onset, and may span over a long period, although they do not seem to be associated with severity in the acute phase or with outcome at follow-up. Aggressive immune therapy at onset may reduce risk of relapse.What This Paper Adds: Relapses of anti-N-methyl-D-aspartate receptor encephalitis may span over a long period. Relapses were not associated with severity in the acute phase or outcome at follow-up. Aggressive immune therapy at onset appears to decrease risk of relapse. [ABSTRACT FROM AUTHOR]

Background: Several studies reported a reduced rate of accesses to pediatric emergency department (ED) for seizures during COVID-19 pandemic. The aim of our study is to evaluate the attendance to pediatric ED for seizures, as well as the influence of seizure type and personal history of seizures on the rate of admissions during the pandemic period., Methods: The number and clinical features of patients admitted to the pediatric ED because of seizures were collected at a single hospital in Milan, Italy, between January 2017 and December 2021. The impact of COVID-19 on the rate of admissions was quantified by using the incidence rate ratio (IRR), comparing the pandemic period (March 2020 to December 2021) to the pre-pandemic (January 2017 to February 2020)., Results: During the study period, 1091 patients with seizures were evaluated, 776 (71.1 %) before the pandemic and 315 (28.9 %) during the pandemic. Mean age at evaluation was 3.9 years (range: 1 month to 17 years). During the pandemic, we found a 30 % decrease in evaluation rates per month (IRR, 0.70; 95 % CI, 0.58-0.84), as well as an increased rate of unprovoked seizures (44.8 %, vs 26.5 %, p < 0.001) and focal seizures (29.5 % vs 13.1 %, p < 0.001)., Conclusions: Our study showed a reduction in the number of emergency evaluations for seizures during the COVID-19 pandemic. The rate of evaluations was influenced by seizure type and previous history of seizures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Neonatal seizures are relatively common, but their diagnosis and management remain challenging. We reviewed the scientific literature on neonatal seizures from July 1973 to November 2023. Several parameters were considered, including pathophysiology, diagnostic criteria, electroencephalographic findings and treatment. Recent classification system of seizures and epilepsies in the newborn, as well as treatment recommendations of neonatal seizures, have been proposed. Nonetheless, the approach to neonatal seizures varies among clinicians and centres, including detection, investigation, treatment and follow-up of patients. There are still many issues on the diagnosis and treatment of neonatal seizures, including the meaning or relevance of some electroencephalographic findings, the precise estimation of the seizure burden, the limited efficacy and side effects risk of antiseizure medications, and the best measures to establish the outcome.