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Neonatal Seizures Differential Diagnoses

  • Author: Raj D Sheth, MD; Chief Editor: Amy Kao, MD  more...
 
Updated: Apr 15, 2016
 
 

Diagnostic Considerations

Benign sleep myoclonus

The clinician should be familiar with this benign condition, in which rhythmic movements (which occur only during sleep) mimic seizures. The condition can be alarming and may occur focally during nonrapid eye movement (non-REM) sleep. Video EEG monitoring shows no electrographic seizures.

Jitteriness

Jitteriness must be differentiated from seizures in neonates. Jitteriness is not associated with ocular deviation. It is stimulus sensitive (eg, easily stopped with passive movement of the limb). The movement resembles a tremor, and no autonomic changes are associated with it.

Seizures often are associated with ocular deviation and are not stimulus sensitive. Autonomic changes frequently accompany them. The movements are clonic, unlike the tremorlike movements of jitteriness.

Other conditions to consider in the differential diagnosis of neonatal seizures include the following:

  • Anoxia
  • Benign epilepsy syndromes
  • Mitochondrial cytopathies
  • Myoclonic epilepsy
  • Myoclonus
  • Organic acidurias
  • Pyridoxine-dependent epilepsy
  • Subarachnoid hemorrhage
  • Subdural hematoma
  • Tuberous sclerosis
  • Vein of Galen malformation
  • Viral encephalitis
  • Viral meningitis

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Raj D Sheth, MD Chief, Division of Pediatric Neurology, Nemours Children's Clinic; Professor of Neurology, Mayo College of Medicine; Professor of Pediatrics, University of Florida College of Medicine

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, Child Neurology Society

Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from Express Scripts.

Acknowledgements

Robert Stanley Rust Jr, MD, MA Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Onset of neonatal seizure demonstrating a focal onset in the right frontal (FP4) region. At this point, the child had head and eye deviation to the left.
Twenty seconds into a seizure that had focal onset in the right frontal (FP4) region, the seizure shows a rhythmic buildup of activity in the right frontocentral region.
This seizure had focal onset in the right frontal (FP4) region and subsequent buildup of activity in the right frontocentral region. As the seizure evolves, the electroencephalogram shows diffuse involvement of both cerebral hemispheres.
 
 
 
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