Neonatal seizures and metabolic epilepsies

The neonatal period is the most common time for seizures to occur over the lifespan. The etiology can be quite varied and considerations include traumatic (related to birth process), vascular (ischemic/hemorrhagic stroke), electrolyte abnormalities, structural, or due to an underlying genetic or metabolic disorder. In approximately 50% of neonates, seizures can be refractory to first-line therapies. In neonates who have medically refractory seizures and status epilepticus of unknown etiology, further evaluation should be performed for metabolic and genetic causes which may have alternative treatment options. Additional clues to a potential underlying disorder include dysmorphic features on examination, structural neuroimaging abnormalities (callosal dysgenesis, sulcal/gyral abnormalities, abnormal spectroscopy, etc.), encephalopathy, and suppression-burst pattern on EEG.