Neonatal seizures and neonatal epilepsy: Urgent need for training programs

Neonatal seizures (NS), even short lived, may signify serious underlying problem that occur in immature brain. It may lead to horrible long term adulthood comorbid neurological, behavioral and psychiatric disorders. Experimentally, even single episode of neonatal seizures permanently affects cognition and memory [1].
Neonatal Seizures are considered as a neurological emergency requiring urgent intervention especially in case with potentially treatable etiologies. The prevalence of NS is about 1.5% and overall incidence about 0.3% live births. The incidence is so higher in pre-term infants (57–132 per 1000 live births). About 80% of NS occur in the 1st week of life [2].From literature, 7:16% of neonates with NS may be died (higher for preterm infants). Among survivors; adverse neurodevelopmental sequelae will take place in 27-55% including cerebral palsy, developmental delay, and postneonatal epilepsy [3].
Neonatal neurology is an emergent sub-specialty area concerning neurologic problems present in the neonatal period. A neurologist with expertise in neonates is becoming more needed [4]. Few neonatologists are interested in neonatal neurology; they considered it as a subject of ambiguity and mystery. Dealing with NS is challenging, especially, for neurologists who aren’t involved in neonatology practice. This may due to dissimilarities and special characteristics of neonates when compared with those of older age groups. In NS; various etiologies should be considered notably hypoxic ischemic encephalopathy, neonatal stroke, kernicterus, traumatic brain injury and metabolic causes. Most NS are subclinical occurring without overt clinical correlate and having the same prognosis as electroclinical seizures [5]. Clinical seizure types in neonates are focal-clonic, focal-tonic, some types of myoclonic, and epileptic spasms. In addition to clinical skills, video EEG monitoring can be used to exclude seizure mimickers including non-seizure behaviors and non-epileptic paroxysmal events as benign neonatal sleep myoclonus, benign non epileptic myoclonus of early infancy (benign non-epileptic infantile spasms) and hyperekplexia. Diagnostic procedures for NS including; biochemical laboratory workup, striking electrophysiological and neuroradiological findings; all have different implication and values in neonates, and lastly; special considerations regarding potentially toxic anti-epileptic medications and other therapeutic modalities should be taken when used in little infants with immature brain, liver and kidneys. Although, most NS are mainly acute, symptomatic and reactive to a specific distinguishable cause [6], rare distinct early neonatal epilepsy syndromes may occur. Benign familial neonatal epilepsy, early myoclonic encephalopathy, and early infantile epileptic encephalopathy are well known neonatal epileptic syndromes. Understanding genetic heritages for these syndromes are being increasingly acknowledged [7]. Urgent need to understand possible underestimated underlying treatable neurometabolic issues is a matter of necessity in dealing with refractory neonatal epileptic syndromes [8]. So, NS and neonatal epilepsy syndromes may represent a neglected area in medical practice among non- neonatologist primary care providers and adult neurologists in one side and neonatologists not interested in neonatal neurology in the other side. Bridges can cross over barriers and physicians can gain much benefit from comprehensive neonatal neurology training programs.