What are seizures?
It is frightening for any parent to find your baby experiencing a seizure. Seizures occur when the nerve cells in the brain fire faster than usual as a result of nerve damage or problems with the brain's chemistry. Seizures cause involuntary movements or changes in consciousness or behavior and affect normal brain function in various ways; sometimes slightly and other times significantly. In newborns, seizures are different from those experienced later in life. They are often subtle and difficult to differentiate from other normal behaviors a baby might display.
What are the different types of seizures?
There are many kinds of seizure disorders, with a variety of symptoms. In newborns, seizures may be difficult to recognize. Very generally, seizures may be classified as either partial or generalized. In partial seizures, the electrical discharges occur in only one area of one side of the brain. In generalized seizures, the electrical discharges are initially present in both sides of the brain.
Partial seizures are the most common types of seizures and can occur at any age. They originate in one side of the brain. The signs vary considerably and relate to the specific functions that are controlled by the brain areas involved. Very simply, partial seizures are divided into two major categories, simple and complex. Simple partial seizures occur in full consciousness; complex partial seizures occur with impaired awareness that ranges from slight to complete unconsciousness.
Simple partial seizures are seizures where the baby will not lose consciousness. This seizure type may cause stiffening or jerking in just one extremity or on one side of the body. The seizures typically last less than one minute. A baby may show different symptoms depending upon which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), your infant's sight may be altered. Muscles are typically more commonly affected. The seizure activity is limited to an isolated muscle group, such as fingers or to larger muscles in the arms and legs.
Complex partial seizures appear different from infant to infant depending on the affected area of the brain. However, an individual infant will usually have the same seizure pattern every time. Complex partial seizures affect a larger area of the brain than simple partial. It can be hard to identify complex partial seizures in an infant because their nervous systems are less developed than those of older children and adults. An infant may suddenly stop what he is doing; his hand or arm may jerk rhythmically, and holding the arm will not stop the jerking. A baby may raise one or both arms or move his head to one side. Typically, a complex partial seizure starts with a blank stare. Actions and movements are typically unorganized, confused and unfocused, again difficult at times to perceive in an infant. Other behaviors or symptoms that may be neonatal seizures are the following:
- Rapid eye movements
- Fixation of gaze to one side
- Sudden flexion of the arms, forward flexion of the trunk, extension of the legs
- Blinking/fluttering of eyelids
- Long pauses in breathing (apnea)
- Body aligned to one side
- Repeated extending of the tongue or other mouth movements such as chewing, lip-smacking, gulping, swallowing or spitting.
Generalized seizures affect both sides of the brain from the beginning of the seizure. They produce loss of consciousness, either briefly or for a longer period of time. Generalized seizures are sub-categorized into several major types: tonic clonic; myoclonic; and absence.
- Tonic-Clonic ("grand mal") seizures are the most common type of generalized seizure. Muscles throughout the body may stiffen briefly, and cause unconsciousness. These major spasms can occur during sleep or while awake, typically lasting for one to several minutes and becoming progressively slower and less extensive. After this phase of the seizure, there can be rhythmic repetitive body jerks. A baby may have trouble breathing and may drool and have a bluish discoloration around the mouth.
- Infantile Myoclonic Seizures (Infantile Seizures) produce sudden, brief, involuntary muscle contractions involving one or several muscle groups. These contractions usually produce movements such as dropping the head and flexing the legs, trunk, or arms. The episodes last only seconds and can occur many times a day.
- Absence (Petit Mal) Seizures cause a brief, abrupt loss of consciousness or awareness for a few seconds followed by a rapid, complete recovery. During petit mal, or absence seizures, babies will lose their sense of awareness and not respond to stimuli, often staring into space. Often, the baby's eyes may blink rapidly, but the baby is not aware of what is occurring. Absence seizures happen briefly, without warning and may occur several times during the same day.
What is the frequency of seizures in newborns?
The incidence of seizures is higher in the first 4 weeks after birth than in any other age group. The incidence of seizures in newborn or premature infants is estimated to be around 80-120 cases per 100,000 babies per year. Of newborns with seizures, about 22 percent will have more than one form of seizure but one form usually predominates.
What causes seizures?
Seizures in newborns can be caused by brain injuries occurring at the time of birth, which deprive the brain of oxygen. Infants with cerebral palsy are at high risk for seizures because brain damage or scarring can spark the abnormal electrical activity. About one out of two infants with cerebral palsy develops seizures. Cerebral palsy is a disorder characterized by damage to the areas of the brain that regulate movement and posture. It results from damage to the brain before, during, or soon after birth.
Medical mistakes can cause seizures. If a doctor or other health care professional fails to monitor or to respond properly to certain situations that arise during the delivery, that individual could be considered negligent with regard to the duty owed to patients. A delivery medical team should monitor the mother and baby throughout pregnancy, labor and delivery in order to be aware of any complications that may develop. Negligence of doctors, nurses, (See "Nursing Negligence") and other medical personnel can lead to situations which may result in seizures. Examples of such negligence include:
- Failure to provide appropriate prenatal care and appropriate interventions during labor and delivery
- Failure to diagnose and treat an infection in the mother
- Failing to rapidly diagnose and treat preterm labor
- Failure to diagnose macrosomic (large) baby
- Failure to properly manage prolonged or post-term pregnancy
- Failing to respond appropriately to bleeding
- Failure to treat maternal elevated blood pressure (preeclampsia)
- Negligent management of labor and delivery
- Failure to appropriately respond and intervene to non-reassuring fetal heart monitor changes and evidence of fetal distress.
- Misuse of a vacuum extractor or forceps during delivery
- Failure to perform a timely vaginal delivery or a cesarean section (c-section) to deliver a baby in distress
- Failure to properly resuscitate a newborn
Newborns with seizures related to brain injuries may have other complications, such as cerebral palsy, mental retardation, and other neurological problems. Only a careful review of the medical records can support a likely cause of injuries and whether the actions of the delivery team played a part in causing your child's seizures. Our lawyers and medical advisors who handle birth injury cases have experience investigating medical mistakes and birth injury malpractice and have access to the type of qualified medical experts necessary to review complicated birth injury cases.
If your child suffered a birth injury resulting in seizures due to improper care during your pregnancy or at the time of delivery, perhaps we can help. Contact one of our medical advisors - all professionally licensed - they will understand the complex issues of labor and delivery that can result in medical conditions like cerebral palsy. Please call our Medical Malpractice group which handles birth injuries that result in cerebral palsy at 1.800.552.7115 or contact us. If you think you have a medical malpractice case within MN, ND, SD, IA or WI, please call 1.800.207.6771.
Geralis, Elaine, (1998) Children with Cerebral Palsy: A Parent's Guide
, Woodbine House, Inc., 1991.
Pellegrino, Louis. Cerebral Palsy, in Batshaw, M.L. (ed.), Children With Disabilities, Fourth Edition, Baltimore, MD, Paul H. Brooks Publishing Company, 1997, pages 499-528.
Wical, Beverley, M.D. The First Unprovoked Seizure
, A Pediatric Perspective, Gillette Children's Special Healthcare Publication, Vol.8, No.3, March, 1999.
Cerebral Palsy Parent http://www.cpparent.org/index.html
National Institute of Health http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm
Epilepsy Foundation http://www.epilepsyfoundationmn.org/
Gillette Children's Specialty Healthcare http://www.gillettechildrens.org/
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