新生儿惊厥诊断分类、发生机制与治疗现状

Neonatal seizures:classification,pathogenesis,and current perspectives in treatment

惊厥发作是新生儿期常见的临床症状之一。多数新生儿期惊厥发作为急性病变所导致的一过性症状, 但也有少数情况是属于新生儿期起病的发育性癫痫性脑病或良性家族性(或非家族性)新生儿癫痫综合征。连续性视频脑电图监测是诊断新生儿惊厥的金标准, 复杂的惊厥发作需要结合同步肌电图、血氧、心电及呼吸监测等多导监测进行综合判断。2021年国际抗癫痫联盟(ILAE)发布了最新的新生儿惊厥分类指南, 提出了仅有临床发作而没有脑电图依据不能诊断新生儿惊厥, 并根据是否伴临床动作及发作期脑电图改变特点, 分为电-临床发作和电发作两种类型。根据发作期临床表现, 将电-临床发作分为运动性发作、非运动发作、序贯性发作和不能分类的发作。2023年ILAE制定了抗惊厥药物管理的循证推荐意见, 基于最新循证对新生儿惊厥的治疗进行了探讨, 强调了视频脑电图对新生儿惊厥疗效评估的重要性。苯巴比妥仍为一线抗惊厥药物, 苯妥英、左乙拉西坦、咪达唑仑或利多卡因作为二线药物。一、二线药物效果不佳时应考虑应用吡哆醇治疗新生儿惊厥。

Seizures are a prevalent clinical manifestation during the neonatal period.The majority of neonatal seizures are transient symptoms caused by acute lesions,but in a few cases they are developmental epileptic encephalopathy with neonatal onset.Continuous video-EEG monitoring is the gold standard for diagnosing seizures in newborns,and complex seizures require comprehensive judgment using multi-channel monitoring such as synchronized EMG,blood oxygen,ECG,and respiratory monitoring.In 2021,the International League Against Epilepsy(ILAE)published the updated guidelines for the classification of neonatal seizures,proposing that neonatal seizures cannot be diagnosed if there is only clinical seizure without EEG evidence.Instead,they should be categorized into two types based on the presence of clinical movements and the characteristics of EEG changes during the seizure:electroclinical seizures and electrical seizures.Electroclinical seizures are categorized into motor seizures,non-motor seizures,sequential seizures,and unclassified seizures based on the symptoms exhibited during an attack.In 2023,the ILAE developed evidence-based recommendations for the management of antiseizure medications,discussed the treatment of neonatal seizures based on the latest evidence and emphasized the importance of video EEG in the treatment of neonatal seizures.Phenobarbital remains the first-line antiseizure medication,with phenytoin,levetiracetam,midazolam,or lidocaine as second-line agents.Pyridoxine should be considered for the treatment of neonatal seizures when first-and second-line drugs are ineffective.