Shadowing Practice: NEONATAL seizures! Work-up and TREATMENT!! - Learn English Speaking with Video
Kies een oefenmodus
Elke modus opent een volledig scherm oefenruimte.
381 zinnen
Als zinnen te kort of te lang zijn, klik op Bewerken om ze aan te passen.
1
now because you just watched the first video on seizures you know what a seizure is
2
and how we diagnose them and hopefully you've been applying your clinical skills in the NICU.
3
However that isn't really that helpful unless you know how to figure out what caused the seizure
4
because most seizures are provoked and how we treat them.
5
So that's what we're going to be covering today.
6
Hi, I'm Dr. Tala and I've been a neonatologist for 17 years now.
7
And today in our follow-up video, we are going to be discussing what causes the seizures, how do we find the underlying cause, how do we treat seizures,
8
and what the prognosis is for infants that actually have had a seizure.
9
Let's start with one.
10
What causes seizures?
11
Well, as you can imagine, anything that messes with a baby's brain has a potential to cause seizures.
12
The other important thing that you should realize in neonates, as opposed to older kids and adults, is that the vast majority of the seizures are provoked.
13
That most of the time something is causing the seizure to happen and it is a short occurrence.
14
And if we get rid of whatever caused it to happen, then hopefully the baby won't have any more seizures.
15
This differs from epilepsy.
16
And remember that epilepsy is when somebody has at least two or more unprovoked seizures with no obvious underlying cause.
17
So for example, if a baby has meningitis and then has a seizure, even if they have two or three seizures,
18
then this doesn't count as epilepsy because the baby is getting seizures because of the meningitis.
19
Relatively few of the seizures that are actually diagnosed are idiopathic, which means that we don't really know why they happen.
20
or considered neonatal epilepsy syndromes.
21
And this is where there are actual structural or genetic abnormalities or an inborn error of metabolism
22
that is causing the baby to actually have these seizures.
23
Obviously, even though it is quite rare as a cause of seizure, it is very important to pick up on them, not just for treatment, but also for prognosis.
24
What are the most common causes of seizures?
25
Well, in term babies, it's HIE or hypoxic ischemic encephalopathy.
26
And normally these seizures happen six to eight hours after the insult.
27
So basically six to eight hours after birth and can happen up to about 24 hours of life.
28
They can also happen as the baby's being rewarmed if the baby's being cooled.
29
So that's also another aside.
30
When the baby has a seizure can also help you kind of figure out what's causing that seizure.
31
In preterm babies, as you can guess, the highest cause for having a seizure would be a bleed, specifically an IVH.
32
Overall though, anything that messes up with the functioning of the brain, whether it's a mass, a bleed,
33
a metabolic abnormality, anything really can actually end up causing a seizure.
34
Look at this pie chart from the New England Journal of Medicine, and you can see like the relative causes of each etiology causing the seizure.
35
Obviously, these are kind of like broad categories
36
and it doesn't go into the minute details of all the tiny different things that can cause a seizure.
37
And in reality, there's probably a bit of overlapping in the seizure etiology.
38
So check out this chart from Pediatrics in Review
39
and you can see all the different large groups of causes of things that cause seizures.
40
You can see that the percentages are actually a little bit different from the New England Journal of Medicine one.
41
And you have to realize that in your unit, there's going to be different percentages of what's causing seizures.
42
If you don't have any preemies in your unit, then you are not going to have a lot of IVHs causing seizures.
43
Let's cover a few more of those etiologies, just kind of like in a very broad context.
44
So like we already said, in a premature baby, they're more likely to have an IVH.
45
But an older baby could also have, or a preemie baby could have a bleed elsewhere as well.
46
For example, a subdural hematoma, if there's trauma at the time of delivery, also a subarachnoid hemorrhage.
47
Both of these can end up in seizures in babies.
48
Perinatal arterial ischemic stroke can happen usually from an embolism.
49
So like a little clot travels up through the blood vessels and then ends up in an artery in the brain.
50
So that area of the brain onwards doesn't get all the blood that it needs.
51
Often that embolism can come from like the placenta or the umbilical cord, or really just about anywhere in the body.
52
If a baby does have a stroke, the most common finding that they actually have is a seizure.
53
Often it is like a focal seizure as well, a focal clonic seizure, now that you know those words.
54
And normally it will happen kind of 24 to 72 hours after birth.
55
A perinatal stroke should be considered in this situation, especially if there are these risk factors.
56
So if the mother has oligohydramnios, choryoamnionitis, premature rupture of the membranes, preeclampsia, diabetes, or a smoking history.
57
And the infant has risk factors as well.
58
All the infant has risk factors such as congenital heart disease, an infection, coagulopathy.
59
Also, boys are more likely to have an ischemic stroke than girls.
60
Since most of the strokes are most likely to happen in the middle cerebral artery, which also covers the area of the motor cortex,
61
these babies are most likely to present with like a clonic focal seizure.
62
So again, pretty easy to pick up.
63
And if you see it, then you can be pretty certain the baby is having a seizure.
64
Also acute metabolic disturbances can cause seizures.
65
So for example, having abnormal electrolytes.
66
So as you all know, if you have hypoglycemia, if you have hypocalcemia,
67
hyponatremia, or hypernatremia, so low or high sodium, or a hypomagnesemia, these can all cause neonatal seizures.
68
Realize that even if a baby does have a seizure, if you then correct the metabolic abnormality, then the seizures should stop.
69
And these are babies that don't need to be on anti-seizure medications.
70
And of course, acute symptomatic seizures can also be caused by infections.
71
So for example, a group B strep meningitis or a harpy simplex virus encephalitis.
72
And this is obviously one of the important things to think about.
73
As we've all gotten so much better at preventing and treating these babies, this cause as a cause of seizures is definitely going down.
74
And then there are so many brain abnormalities that can end up with seizures, whether it's a congenital brain malformation,
75
for example, a schizencephaly or lysencephaly, or whether there is a tumor in the brain or a bleed in the brain of uncertain etiology,
76
whether it's hydrocephalus.
77
So there are a lot of structural abnormalities that can end up presenting because a baby does have a seizure.
78
Two, how do we go about finding the underlying cause for the seizure?
79
Before we get to the diagnostic algorithm, I just want to talk briefly about the importance of getting a good family history,
80
birth history, perinatal history, as well as doing a good physical exam
81
to make sure that you're not missing any other reasons for why the baby might be having a seizure.
82
We'll start with a family history.
83
Obviously, if the mother tells you that she has generations of her family that have had epilepsy,
84
then there's a high chance that there is a genetic reason for why this baby might end up having a seizure.
85
And it really is epilepsy in this situation, as in not an acute reason for provoking the seizure.
86
Some seizures, for example, those due to non-ketotic hyperglycinemia, an inborn error of metabolism, may start in utero.
87
And the mother may report that she had these frequent episodes of like this rhythmic jerking by the baby.
88
Sometimes the mothers think that the babies are hiccuping and really after the baby's born, we figure out that the baby's actually having seizures.
89
I don't want anybody to watch this thinking when their baby's hiccuping that they're really seizuring.
90
Babies hiccup a lot, so don't freak out.
91
I'm just saying it's easy to look the other way.
92
Now let's move on to the physical exam.
93
Obviously, you should be doing a really good physical exam
94
because it can also reveal things for why the baby might be having a seizure.
95
So if the baby has microcephaly or a really small head, then maybe the baby has cerebral dysgenesis or has a genetic abnormality
96
or baby has an infection like a torch infection that's causing the seizure.
97
Macrocephaly or like a huge head, often that's associated with hydrocephalus, that can be associated with a structural abnormality or a genetic abnormality.
98
For example, babies, especially baby boys because it's X-linked, can be born with an aqueductal stenosis.
99
Really, anytime a baby has any abnormal dysmorphic features, then you should be concerned that something is going on with the brain.
100
This is especially true when the abnormal features are like central.
101
So for example, if there is something abnormal with the nose, or you have a central incisor, or for example, you have seizures and a cleft palate,
102
I would be very worried that there is something abnormal with the brain.
103
Other things that you should be looking at is like hyper or hypotelerism, if the eyes are too close or too far apart from each other.
104
So really take a very good look at the baby for dysmorphic features.
105
Then take a very good look at the baby's skin because abnormalities you find may suggest a neurocutaneous syndrome.
106
For example, in neurofibromatosis, you might see cafe au lait patches, which are actually very difficult to see in the newborn period.
107
In tuberous sclerosis, you may see ash leaf spots.
108
Actually, tuberous sclerosis is one of the few neurocutaneous syndromes where the babies may start having seizures in the neonatal period.
109
So again, you're looking for ash leaf spots in tuberous sclerosis.
110
Or as you would definitely not miss, you may see a port wine stain in Sturge Weber syndrome.
111
Or you could see a rash suggestive of incontinentia pigmenti, which honestly I've never seen, but I've had to study.
112
And it's a very rare disease.
113
It's X-linked dominant.
114
And it starts off looking like a blistering rash, and then it devolves into kind of like wart-like lesions.
115
This can be associated with neurological abnormalities including seizures.
116
Obviously do a good cardiac exam.
117
If the baby does have congenital heart disease then the baby is at increased risk of having a stroke.
118
So that's the board answer with a congenital heart disease and focal seizures.
119
The baby had a stroke.
120
And then overall what does the baby look like?
121
Does the baby seem to have some sort of encephalopathy?
122
So something actually affecting the underlying functioning of the brain Is the baby sleepy and lethargic?
123
Is there decreased tone?
124
Is there increased tone?
125
What are the reflexes like?
126
What's the suck like?
127
What are the pupillary reactions like?
128
So you can have an overlying feel of whether this is something very specific in the brain
129
or whether the whole body seems to be affected.
130
After you take a good history and perform a good physical exam, you can start going down the diagnostic algorithm.
131
So for now, what I'm going to follow is the diagnostic algorithm put forward by Dr. Jozawicz in the New England Journal Medicine article.
132
Let's go through this beautiful diagnostic algorithm.
133
The first thing is, if you think the baby is having a seizure, then do some blood work immediately.
134
Obviously, the easiest things to rule out would be some electrolyte abnormalities.
135
So send a set of electrolytes, so you're checking the sodium, the calcium, the glucose, the magnesium, making sure that those aren't the obvious causes for the seizure.
136
They also recommend just getting a CBC, even though it's not a great screening test for an infection, it's not sensitive or specific,
137
it's very easy to get and it's a bedside.
138
So get that as well.
139
And then if you are suspecting a seizure, then try to start setting up an EEG.
140
Obviously, it is well acknowledged that actually getting the EEG in place does take some time.
141
Obviously, if the baby had a seizure because of an abnormal electrolyte issue, then you need to correct that.
142
Or if you think the baby has an infection, then obviously treat for the infection.
143
If the baby, like we already said, did have a seizure because of an abnormal electrolyte issue, it is very unlikely that that baby is going to need an anti-seizure medication.
144
Just correct the electrolyte issue.
145
If those previous studies didn't reveal the underlying cause, then we have to broaden the differential.
146
So one of the first things that you then get is a blood gas
147
or preferably an arterial blood gas to check for acidosis
148
if the baby does have severe acidosis then maybe it was just the hypoxemia
149
and the acidosis that caused the baby to have a seizure just like in a baby with hie
150
but also it's important to know just how sick the baby is
151
or how acidotic the baby is because if the baby is acidotic and the brain already isn't getting enough oxygen,
152
then anything else that the baby might be going through, like a borderline low sugar or something else, is a lot more likely to cause a seizure.
153
Like a lot of things in medicine, if two things are bad, not just one, then you're much more likely to have that worse outcome.
154
Then evaluate for infection.
155
At this point, you're doing definitely more than just sending a CBC.
156
You're probably sending cultures, probably a blood culture, a urine culture, depending on how old the baby is.
157
And then at this point, you're probably also doing some sort of screening for torch infections.
158
So for toxoplasmosis, for rubella, CMV, herpes simplex virus, HIV, hepatitis, syphilis, the whole nine yards,
159
all of these can cause seizures.
160
You should be performing a lumbar puncture or a spinal tap.
161
I was actually taught that literally any time a baby has a seizure, unless there is a very clear, obvious reason for it.
162
So baby, a preemie baby has like a massive head bleed
163
or a baby has a sugar of five for like three days, then we should be doing a spinal tap.
164
Remember that if you do a spinal tap, then make sure that you try to keep extra CSF.
165
So keep an extra bottle with extra fluid in it because
166
if we don't have an infectious reason or the tests that you send don't actually give us the answer,
167
then neurology may come back and ask for all these like metabolic labs
168
that they want to send on the CSF to make weird diagnoses of inborn errors of metabolism.
169
Another caveat here, if you think that the baby is having seizures because of an infection, but the baby is too unstable to actually tap,
170
do not stop from treating before you get the tap.
171
Obviously, anytime that you're worried that a baby is really sick from an infection, you want to get those antibiotics or those antivirals in as quickly as possible.
172
In this algorithm, it actually says at this point to perform genetic testing.
173
This is a bit interesting to me because it is kind of quite early on.
174
Other references suggest actually sending genetic testing if the initial evaluations come back negative and the imaging and everything is negative,
175
or if there's a strong family history of having epilepsy.
176
There are genetic panels that you can send.
177
So you can send the specific study for epilepsy, all the different genes that are involved in possible epilepsy syndromes.
178
So just be sure that if you are sending that panel at this point, you really should have a neurologist or a geneticist involved, just to make sure that you're sending the right one.
179
Obviously, at some point, we need to be doing neuroimaging.
180
If a baby has a seizure, even if you think it is from meningitis, then you should be getting some sort of neuroimaging to make sure
181
that nothing else is going on structurally or the baby doesn't have a bleed or something else abnormal as well.
182
As you all know, the ultrasonography or an ultrasound of the brain is always kind of like our first line step.
183
And we can do it because the babies have the anterior fontanelle.
184
So we have a window into their brain.
185
They are quick.
186
They are easy to use.
187
We can do it at bedside so we don't have to transport a sick kid.
188
And we can get the results very, very quickly and
189
because of the ease of access it is recommended at this step just to get the ultrasound first
190
and ultrasounds are still really good at detecting bleeds especially the
191
larger bleed they might miss some tiny ones maybe would miss a tiny subarachnoid hemorrhage or a tiny subdural
192
hemorrhage they are not as good at getting stuff in the posterior aspect of the brain
193
and you may miss some avms or vein of gallon malformations
194
and stuff like that but overall as an initial screening test to look at the brain, they're fantastic.
195
The other slight caveat that you have to realize is that ultrasounds are user dependent.
196
So the pictures are only as good as the images that are obtained by the ultrasound technician.
197
As part of this step, we should be monitoring the EEG.
198
Obviously, at this point that we don't have an obvious reason for the seizures, we're still trying to figure out what's going on, we're still worried about the seizures,
199
we really should be monitoring the electrical activity of the brain at this point.
200
And like we already said,
201
this EEG should be monitored continuously even as we start the baby on the anti-epileptic medication because sometimes the electrical activity,
202
the electrical seizures continue even if the baby clinically doesn't look like it's having a seizure any longer.
203
So make sure that you're continuing to monitor the baby on the EEG.
204
We should also be monitoring the baby on an EKG or the electrocardiogram, just monitoring the baby's heart rate and the SATs and everything.
205
If a neonate is seizing, hopefully you've already moved them to the NICU and you are actually putting them on a monitor and watching that.
206
Sometimes, very rarely, arrhythmias can actually cause seizures.
207
But really why this is more important is
208
that we can see the autonomic signs of seizures on the EKG
209
and make sure that the baby is stable even if the baby is having seizures.
210
So yes, definitely be monitoring these babies.
211
Obviously, at this point, if you found out what's causing the seizure, then you should be trying to actually treat that cause if you can.
212
So if it is hyperglycemia or if it is herpes encephalitis, then make sure that you do start acyclovir,
213
whatever it is that you think is causing it, as well as actually treating the seizures.
214
If the baby is still having seizures and you still don't know what caused it,
215
then we have to start going down more diagnostic pathways into kind of like even more rare stuff that could be happening.
216
One of the next steps is to perform an MRI.
217
I would argue that really, anytime a baby has a seizure, you're probably going to end up with an MRI.
218
Even if you don't actually have the, even if you have an etiology for it, even if you see a bleed on an ultrasound,
219
as you all know, an MRI can give much more details of the structure of the brain, the extent of the bleed,
220
the amount of hypoxic ischemic damage that occurred, lots of other things that could be missed on an ultrasound.
221
So really, most of the time that a baby is having a seizure, we would want to get an MRI, but especially if we don't have a reason for it.
222
As you all know, generally, we're taking babies It's too radiology to get an MRI.
223
There are a few portable MRI machines.
224
So generally, the baby has to be stable enough to actually transport them to MRI.
225
By the way, if you are suspecting a stroke based on clinical features, so for example, like we said, we're seeing that focal clonic jerking or the focal clonic seizures,
226
then not just an MRI would be recommended, but an MRA and MRV, which is magnetic resonance angiography and venography.
227
So that's where they're actually putting the dye into the arteries and the veins, and you can get a really good idea about whether there was a stroke
228
or whether there was an embolus or something in those areas.
229
So consider that if you think that the baby has a stroke
230
or if the MRI actually is indicative that the baby did have a stroke.
231
If the baby is still having seizures and you've already tried the conventional anti-seizure medications and nothing seems to be working,
232
then at this point, it's recommended to give trials of pyridoxine,
233
pyridoxal phosphate, folinic acid, and biotin to correct uncommon vitamin-responsive epilepsies.
234
Again, very rare, but if you're having these unresponsive seizures, then you really should be trying this.
235
Continuing down the algorithm, then realize that this baby should be on EEG monitoring until the baby is seizure-free, so at least for 12 to 24 hours.
236
You should also be considering inborn errors and metabolites at this point.
237
Like I said, we're getting into the more and more rare causes of the seizures.
238
So if you haven't already sent it, then send an ammonia, a lactate, make sure obviously that the glucose is okay.
239
The acid is okay.
240
At this point, also consider sending the urine organic acids and serum amino acids.
241
Then I'm sure the neurologist will also want some weird metabolites in the CSF,
242
but at least you should be sending glucose and glycine in the CSF.
243
And that's where that extra CSF from the tubes comes in.
244
Other things that you should consider if you haven't done it yet.
245
Again, we said screening for infection.
246
Again, with the emphasis on torch infections and other weird infections that you may be missing.
247
Was anybody in the family sick?
248
Again, we're reaching like rarer, rarer stages here at this point.
249
If you haven't sent any genetic studies, then at this point you should definitely be sending some epileptic genetic panels,
250
or you could do a microarray if that's what you have in your unit, or the whole exome sequencing.
251
Again, I recommend that if you are actually sending genetic testing, then get a neurologist or a geneticist involved just so that you do end up sending the right thing.
252
Other things that you could do is get an ophthalmologist to come and look at the eyes, see if that gives any clues,
253
whether it's a torch infection or anything abnormal with the retina or anything else.
254
Some weird inborn errors in metabolism can present that way.
255
And another thing that you could do is actually look at the placental pathology.
256
That can sometimes give clues like with a torch infection or some sort of embolism or something like that.
257
In all, lots of diagnostic steps.
258
Realize you shouldn't just be throwing the sink at the baby immediately when the baby first has a seizure, especially if it was just because of hyperglycemia.
259
So it's important, go step by step as you're also trying to stop the seizures from happening.
260
We don't want the baby to be in status just while you're waiting to send genetic panels or whatever.
261
Three, how do we manage and treat seizures?
262
Well, like every emergency in medicine, we have to take care of the ABCs.
263
So take care of airway, breathing, and circulation for the babies first.
264
Make sure that the baby is stable and breathing.
265
Then, like we said, the beginning of the algorithm is to immediately send labs, make sure that we're not missing obvious reversible causes of the seizures,
266
the electrolyte disturbances, send a CBC as well, and start antibiotics if that's what you need to do.
267
The goal of treatment of neonatal seizures is to reduce the seizure burden,
268
but also to try to prevent any poor neurodevelopmental outcomes that we would expect if loads of seizures went untreated.
269
Neuronal apoptosis, which is where the neurons, the cells in the brain, undergo a pre-programmed cell death.
270
And poor neurodevelopmental outcomes have been associated with untreated seizures, both in animal as well as human models.
271
So we know that having prolonged untreated seizures is bad.
272
Having said that, there is no high quality data from randomized trials to suggest that actually treating seizures actually helps neurodevelopmental outcomes.
273
And you can imagine just how difficult of a study that is to do.
274
I don't know
275
if I would be willing to randomize into a study where my baby just didn't get an anti-epileptic medication just
276
because we were trying to figure out whether it would affect neurodevelopmental outcome or not.
277
And like we talked about in the previous video, we shouldn't be treating anything that even closely resembles a seizure.
278
We really should only be treating the seizures with EEG correlation.
279
So like if we actually see the seizures on the EEG, unless it is like a clonic seizure that we would expect to see in a stroke or something.
280
So we're not treating every abnormal movement in a baby, even if it looks like a seizure.
281
But there isn't really a lot of data on exactly how
282
or when we should be treating the babies or which medications we should use.
283
And honestly, a lot of the medications that we do end up using
284
and are actually recommended to be used are actually off-label.
285
Then we need to be worried about the actual effects from the anti-seizure medications on the brain.
286
So it has been shown in studies that phenobarbital may affect the development of the brain, may actually induce apoptosis by itself,
287
and may just affect neurodevelopmental outcome.
288
So this is not something that we're just giving very casually.
289
Having said that, it's still felt
290
that the burden of untreated seizures is a lot worse on the developing brain than actually giving the anti-seizure medication.
291
So right now, if there is a documented seizure on the EEG, we should be treating it.
292
The New England Journal article that we keep referencing actually suggests that we should speak to the family about treating seizures,
293
that it's not just such an obvious decision to be made,
294
that we should be weighing the risks and the benefits of giving babies anti-seizure medications and kind of consenting them.
295
So which medications?
296
The ILAE recommends that phenobarbital should be our starting medication to stop seizures, no matter the cause of the seizure.
297
So whether it was HIE or a stroke or IVH, we should be loading babies with phenobarbital first.
298
The recommended loading dose is 20 milligrams per kilogram.
299
And then if you need to give like another little dose, a bolus loading dose, you can give another 10 to 20 milligrams per kilogram.
300
Realize that if you're giving like above 40 milligrams per kilogram in a short period of time,
301
that's when you can really start affecting the baby's respiratory status and the blood pressure.
302
You can end up with respiratory depression and hypertension, and it can really throw off the baby's neurological exam.
303
They can become just really out of it and lethargic just from the medication.
304
We went through this phase of sometimes using Keppra or Leveteracetam, I never really used that word, instead of starting with phenobarb,
305
Keppra does seem to have fewer side effects, even if it's given in higher quantities.
306
And a study from a few years ago showed
307
that maybe babies given Keppra had maybe improved neurodevelopmental outcomes versus those that were given phenobarb.
308
However, a randomized study, so this was Leveterisatam versus Phenobarb for neonatal seizures,
309
the NEOLEV2 study, which was a small 2B randomized controlled trial,
310
it showed that Phenobarbital was more effective than Keppra at 24 hours for the treatment of neonatal seizures,
311
which means that the Phenobarb was much better at stopping the seizures, and that's exactly our goal, to actually stop the seizures from happening.
312
Generally, if the phenobarbital has still not managed to stop the seizures from happening, then we'll give another medication.
313
It's really uncertain which medication we should be giving next.
314
Often we will give Keppra about 60 milligrams per kilogram or a little bit less than that as a bolus,
315
or we'll give phenytoin, which is we give it at a 20 milligram per kilogram ambolus.
316
We could also be giving a midazolam, which is a benzodiazepine, or a lidocaine as well to try to stop the seizures.
317
Again, not a lot of clear evidence which medication we use as a second line drug.
318
This table from the New England Journal article goes over the different medications
319
and the doses that we could use after the phenobarbital.
320
Again, notice that phenobarbital is the only one that's actually FDA approved to treat neonatal seizures.
321
And by the way, all the references are below.
322
The other really interesting thing about phenobarbital is that the volume of distribution of phenobarbital is about one liter per kilo.
323
So let me tell you why this is helpful.
324
Whatever dose we give the baby, so say we give 20 milligrams per kilo of a phenobarbital bolus,
325
the level in blood of the phenobarbital will be about 20 micrograms per ml.
326
And so we know that a therapeutic dose for a baby is somewhere between 10 and 40 micrograms per ml.
327
So we know that if we've given a 20 mg bolus, 20 mg per kg bolus, and then another 20 mg per kg bolus,
328
If we check that level in the baby's blood, most likely it will be very close to 40 micrograms per ml,
329
which is the level that we're looking for.
330
And when do we stop treatment?
331
This is such an age-old question, and if you ask 10 neonatologists, 10 neurologists, you're going to get different replies.
332
Some people say as soon as the seizures are controlled, maybe 24 hours after the seizures are controlled.
333
That's extremely aggressive.
334
Other people say that before the baby leaves the NICU, we can try to come off the anti-seizure medication.
335
Or more traditionally, we've kept them on the anti-seizure medication for a few months.
336
Four, let's talk about the prognosis of neonatal seizures.
337
I'm sure, as you've already gathered, that the prognosis will really depend on what's causing the seizure in the first place,
338
how long the seizure lasted untreated, and as well, whether the seizure was responsive to an anti-seizure medication or not.
339
Obviously, if you have a horrible brain abnormality, then the seizure is just a very small part of contributing to that poor neurodevelopmental outcome.
340
As you can probably guess,
341
the ones with the worst prognosis are the ones with a genetic or metabolic abnormality that kind of have this epilepsy syndrome,
342
that are basically going to exist for life.
343
They're unprovoked, and it's something that's innately abnormal with the baby's brain and with the baby's genes.
344
And so developmentally, they easily have the worst outcome.
345
It has been well-documented, like we've already said, that untreated seizures can cause neuronal apoptosis as well as hippocampal sclerosis.
346
And so that in itself can obviously worsen the outcome.
347
But it's difficult to tease out exactly how much of the bad outcome is from the untreated seizures
348
or from the seizures versus the original brain injury.
349
Data from several case series show that if babies have a long length of seizures in a short period of time,
350
then that will worsen outcome.
351
For example, we definitely don't want babies to be in status epilepticus.
352
So we don't want babies to have seizures for five minutes or longer.
353
That's the definition of status.
354
Also, another set of studies showed that if babies have more than 12 to 13 minutes of seizures within an hour period,
355
then their prognosis is a lot worse as well.
356
So we don't want babies to be like continuously seizing.
357
But there is good news from the other end of the spectrum.
358
And studies show that maybe an isolated provoked seizure, whether it goes away or it's treated with an anti-seizure medication,
359
in animals at least, does not seem to worsen the developmental outcome.
360
In fact, animal studies suggest that maybe the immature brain is less likely to be damaged
361
or injured from a seizure than a more mature brain.
362
There are also certain EEG patterns, so background EEG patterns.
363
So what the brain looks like
364
when the baby is not having a seizure on the EEG that can be more predictive or prognosis.
365
As you can imagine, if the background EEG pattern is normal, then that's more likely to end up with a completely good outcome and a good prognosis.
366
If the background activity has background birth suppression or ictal activity, then these are associated with a worse prognosis.
367
In one study with HIE, it was found that if the babies had a normal or slightly abnormal background EEG,
368
then they were most likely going to end up with a normal development.
369
Another good prognostic sign for HIE and seizures is if the seizures are completely controlled by day of life too,
370
then we can also be optimistic about a good developmental outcome.
371
Last thing I want to say about this, and that is that the background activity of the EEG especially can be really affected by the state
372
that the baby is in.
373
So literally whether the baby is awake or not, which they can figure out on the EEG, but also just if the baby is being cooled or the baby's on a lot of medication,
374
especially anti-seizure medication or other narcotics or benzodiazepines or whatever, that in itself can affect the background activity of the EEG.
375
So sometimes we have to wait until the baby is kind of like in a more normal state
376
or at least completely warmed up before we can trust that background activity, the EEG.
377
And that brings us to the end of our seizure videos.
378
I really do hope that you learned something.
379
If you're interested in a more neonatal education, then please subscribe to this channel and like this video if you did like it.
380
And if you are interested in telling us which videos you want to see next, then please think about joining our lovely community and our channel membership.
381
Again, thank you so much for being here.
App downloaden
Alles wat je nodig hebt om vloeiend te spreken
AI UitspraakScoor elke zin
IPA OefeningBeheers elk geluid
WoordenschatBouw je woordenschat op
WoordenspelLeren terwijl je speelt
FOR YOU
Aanbevolen Video
C11
127 zinnen
Doctor explains DIABETIC RETINOPATHY (eye disease) - STAGES, SYMPTOMS, PREVENTION AND TREATMENT
Daily ConversationUniversity StudentsWorking Adults
C11
91 zinnen
How To: Ultrasound for Pneumothorax Case Study Video
Daily ConversationUniversity StudentsWorking Adults
B26
183 zinnen
Why Babies NEED to Sleep Next to You (Science Explained)
Daily ConversationUniversity StudentsWorking Adults
C12
173 zinnen
What is it? Exercise-induced episodic gait disorder in a young boy
IELTS PrepTOEFL PrepUniversity Students
C11
91 zinnen
Obesity: Causes, Health Conditions, and Treatment | Mass General Brigham
Daily ConversationUniversity StudentsWorking Adults
C11
154 zinnen
Sequential, Multiple Assignment, Randomized Trial Designs With Dr Kidwell
Daily ConversationUniversity StudentsWorking Adults
C13
69 zinnen
Doctor explains TESTICULAR LUMPS: PART 1 - EPIDIDYMAL CYSTS (causes, symptoms and treatments)
University StudentsWorking Adults
B22
130 zinnen
If You Can Understand Him, Your English Is Incredible
British AccentDaily ConversationUniversity StudentsWorking Adults
C11
77 zinnen
Bell palsy
University StudentsWorking Adults
C11
12 zinnen
Stroke Prevention with Intracranial Stenting
Daily ConversationUniversity StudentsWorking Adults
C11
16 zinnen
Cleft Lip & Cleft Palate: Pediatrics - Alterations in Health | @LevelUpRN
Business EnglishUniversity StudentsWorking Adults
B24
35 zinnen
Doctor calmly tries to explain risks to anti-vaccine parents | The Pitt | BINGE
IELTS PrepTOEFL PrepUniversity Students
Woordenschat en spreektips bij deze les
Deze spreekles op niveau C1 is gebaseerd op de video “NEONATAL seizures! Work-up and TREATMENT!!”. Deze woorden komen het vaakst terug: seizure, baby, brain, babies, medication. Deze video bevat 381 zinnen en 5849 woorden om na te spreken. Het gesproken deel duurt 35:44. De spreker praat in een natuurlijk tempo van ongeveer 164 woorden per minuut, dicht bij een alledaags gesprek. Slechts 78% van de woorden hoort bij de 3.000 meest gebruikte Engelse woorden, dus de woordenschat is pittig.
Belangrijke woorden in deze video
De 15 moeilijkste woorden uit de video, met uitspraak en betekenis:
| Woord | Uitspraak | Betekenis |
|---|---|---|
| abnormality zelfstandig naamwoord | /ˌæbˌnɔɹˈmæl.ət.i/ | abnormaliteit |
| abnormal bijvoeglijk naamwoord | /ˌæbˈnɔɹ.ml̩/ | abnormaal |
| epilepsy zelfstandig naamwoord | /ˈɛpɪˌlɛpsi/ | epilepsie, vallende ziekte |
| prognosis zelfstandig naamwoord | /pɹɑɡˈnoʊsɪs/ | prognose, vooruitblik |
| bleed werkwoord | /ˈbliːd/ | bloeden |
| electrolyte zelfstandig naamwoord | /ɪˈlɛk.tɹəˌlaɪt/ | elektrolyt |
| kilogram zelfstandig naamwoord | /ˈkɪləɡɹæm/ | kilogram |
| untreated bijvoeglijk naamwoord | onbehandeld | |
| ultrasound zelfstandig naamwoord | /ʌl.tɹə.saʊnd/ | ultrageluid |
| algorithm zelfstandig naamwoord | /ˈælɡəɹɪðm̩/ | algoritme |
| diagnostic bijvoeglijk naamwoord | /ˌdaɪ.əɡˈnɑ.stɪk/ | diagnostisch |
| inborn bijvoeglijk naamwoord | /ˈɪn.bɔɹn/ | aangeboren |
| metabolic bijvoeglijk naamwoord | /mɛtəˈbɒlɪk/ | metabool |
| torch zelfstandig naamwoord | /ˈtɔːtʃ/ | toorts, fakkel |
| aetiology zelfstandig naamwoord | /i.tiˈɑ.lə.d͡ʒi/ | etiologie |
Phrasal verbs die je zult horen
| Woord | Betekenis |
|---|---|
| end up werkwoord | belanden, terechtkomen |
| figure out werkwoord | uitvogelen, er achter komen |
| go down werkwoord | afdalen |
| come back werkwoord | terugkomen |
| check out werkwoord | onderzoeken |
| find out werkwoord | ontdekken, onderzoeken |
| go away werkwoord | weggaan |
| pick up werkwoord | oppakken, optillen |
Zinnen om te herhalen
Korte, volledige zinnen uit de video die je in alledaagse gesprekken kunt gebruiken:
- We'll start with a family history.
- Let's go through this beautiful diagnostic algorithm.
- Three, how do we manage and treat seizures?
- Four, let's talk about the prognosis of neonatal seizures.
Grammatica in deze video
De structuren die de spreker het meest gebruikt, met de exacte woorden uit de video:
| Structuur | In de video |
|---|---|
| Present perfect have/has + voltooid deelwoord — iets uit het verleden dat nu nog telt | I've been · have had · I've never seen |
| Lijdende vorm be + voltooid deelwoord — het gaat om wat er gebeurt, niet om wie het doet | are provoked · are actually diagnosed · being rewarmed |
| Betrekkelijke bijzinnen who / which + zin — extra informatie over een persoon of ding | idiopathic, which means · patches, which are · MRV, which is |
Uitspraak om op te letten
De spreker gebruikt 86 samentrekkingen en verkorte vormen, zoals don't, you're, we're. Spreek ze kort uit, zoals je ze hoort.
- De “th”-klanken: algorithm /ˈælɡəɹɪðm̩/, encephalopathy /ɛnˌsɛfəˈlɒpəθi/, lethargic /ləˈθɑɹd͡ʒɪk/
- De klanken “sh” en “zh”: seizure /ˈsi.ʒɚ/, rash /ɹæʃ/
- Lange woorden — let op de klemtoon: abnormality /ˌæbˌnɔɹˈmæl.ət.i/, phenobarbital /ˌfiː.noʊˈbɑɹ.bəˌtɔl/, epilepsy /ˈɛpɪˌlɛpsi/, electrolyte /ɪˈlɛk.tɹəˌlaɪt/, diagnostic /ˌdaɪ.əɡˈnɑ.stɪk/
Klanken die Nederlandstaligen lastig vinden:
- Stemhebbende eindmedeklinker — /b/, /d/, /g/, /z/, /v/ niet verscherpen: bleed /ˈbliːd/, ultrasound /ʌl.tɹə.saʊnd/, hemorrhage /ˈhɛm(ə)ɹɪd͡ʒ/, glucose /ˈɡluː.kəʊz/, bedside /ˈbɛdˌsaɪd/
- /æ/ — opener dan de Nederlandse “e”: abnormality /ˌæbˌnɔɹˈmæl.ət.i/, abnormal /ˌæbˈnɔɹ.ml̩/, kilogram /ˈkɪləɡɹæm/, algorithm /ˈælɡəɹɪðm̩/, milligram /ˈmɪlɪɡɹæm/
- /g/ — een harde plofklank, geen Nederlandse “g”: prognosis /pɹɑɡˈnoʊsɪs/, kilogram /ˈkɪləɡɹæm/, algorithm /ˈælɡəɹɪðm̩/, diagnostic /ˌdaɪ.əɡˈnɑ.stɪk/, milligram /ˈmɪlɪɡɹæm/
Zo oefen je met deze video
- Luister de hele video één keer zonder te spreken en noteer de woorden die je niet kent.
- Begin op 0,75× snelheid, spreek zin voor zin na en ga terug naar normale snelheid zodra het makkelijk gaat.
- Neem jezelf op en vergelijk met het origineel; let daarbij op woorden als abnormality, abnormal, epilepsy.
Wat is de Shadowing-techniek?
Shadowing is een wetenschappelijk onderbouwde taalleermethode die oorspronkelijk is ontwikkeld voor professionele tolkentraining en gepopulariseerd door polyglot Dr. Alexander Arguelles. De methode is eenvoudig maar krachtig: je luistert naar native Engelse audio en herhaalt het onmiddellijk hardop — als een schaduw die de spreker volgt met slechts 1–2 seconden vertraging. In tegenstelling tot passief luisteren of grammaticadrills, dwingt shadowing je hersenen en mondspieren om echte spraakpatronen tegelijkertijd te verwerken en te reproduceren. Onderzoek toont aan dat het de uitspraaknauwkeurigheid, intonatie, ritme, verbonden spraak, luisterbegrip en spreekvaardigheid aanzienlijk verbetert — waardoor het een van de meest effectieve methoden is voor IELTS Speaking-voorbereiding en echte Engelse communicatie.