新生儿惊厥的诊断与处理(英文)

Neonatal seizures:diagnosis and management

新生儿会发生各种形式的发作性运动,其中有些是癫癎性的惊厥,有些则不是。如何去识别是件困难的事。目前尚缺乏新生儿惊厥诊断与处理的全球性指南。该讲座在全面复习新生儿惊厥的文献并结合作者丰富的临床经验的基础上提出一个处理新生儿惊厥的方案。新生儿惊厥病因很多,缺氧-缺血性脑病和感染是最常见的原因,新生儿中风、遗传代谢病也逐渐被认识。病因是新生儿惊厥结局好坏的主要决定因素。视频-EEG是鉴别癫癎性惊厥与非癫癎惊厥的金标准。苯巴比妥依然是新生儿惊厥的首选药。足量苯巴比妥治疗无效时可考虑使用苯妥英、咪达唑仑或氯硝安定等。顽固性的惊厥,早期可试用吡哆醇、磷酸吡哆醛、叶酸和生物素治疗。对没有惊厥表现的脑电图发作的是否需要治疗有待于进一步的研究。

The recognition of epileptic seizures in newborns is challenging as neonates exhibit a variety of paroxysmal motor phenomena,some epileptic but others not.The distinction,frequently requiring video-EEG monitoring,is crucial for management.Causes are often multi-factorial,specific to country/region,and change over time.Hypoxia-ischemia and infection are still common in both developed and developing countries.Venous and arterial strokes are being increasingly recognized.Treatable conditions,including inborn errors of metabolism,must be anticipated and considered early in the course.Etiology is the principal determinant of outcome.Management is based on uncontrolled studies and expert opinions.Information on neonatal seizures is reviewed,and suggestions for management provided.Phenobarbital remains the first anti-epileptic drug of choice,worldwide.Pharmacogenetic information and hepatic or renal dysfunction will influence doses of all drugs.The toxicity of excipients present in intravenous medicines should be kept in mind,especially when infusions are given to critically ill neonates.Therapeutic trials with pyridoxine or ideally pyridoxal phosphate,folinic acid and biotin should be considered early,if seizures are intractable.The management of electrographic seizures without clinical seizures needs critical study.When anti-epileptic drug treatment is required,maintenance should be for a short duration if seizures are of an acute symptomatic nature.