Seizures are the most common neurological emergency in the neonatal period and are associated with mortality and long-term neurodisability. In contrast to seizures in older children and adults most neonatal seizures are acute symptomatic and hence require immediate diagnosis and management. However clinical diagnosis is challenging because most have no or only discreet clinical manifestation. Depending on the aetiology, up to 60% of seizures are electrographic only. Treatment with some anti-seizure medication increases percentage due to electro-clinical dissociation. Critically ill infants with a very high seizure burden or in status epilepticus are particularly likely to lack clinical manifestation. Hence, neonatal status is currently defined as a total seizure time occupying 50% of a 30 min recording. In addition, both normal and sick babies often exhibit similar movements which may be mistaken as seizures. Thus, clinical diagnosis is unreliable in most cases making electrophysiological diagnosis a necessity. Polygraphy with 8–16 EEG channels with video is considered the gold standard in the diagnosis of neonatal seizures. Seizures are always focal and are usually ill-sustained lasting less than a minute and are even shorter in preterm infants seizure. Cerebral function monitoring (CFM) is a useful method for prolonged monitoring but misses many focal or shorter seizures and also has a risk of false positive errors, leading to an accurate estimation of the seizure burden. In summary video EEG is essential in the diagnosis and management of neonatal seizures.
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