1. Jitteriness

• usually occurs in newborns with perinatal asphyxia, metabolic disorders and in newborns of addicted mothers

2. Opisthotonos

• caused by meningeal irritation and seen in kernicterus, infantile Gaucher disease and some aminoacidurias

3. Others

• apneas, nocturnal myoclonus, sleep or arousal behaviour

1. Eyes

• sustained opening, ocular movements, blinking, tonic horizontal deviation

2. Oral

• chewing, drooling, sucking, laughing

3. Apnea

• full term > premature (rare)

4. Motor

• boxing, hooking, rotary, pedalling, stepping movements of extremities

5. Autonamic

• elevated blood pressure and heart rate
• more common in premature than in full-term infants
• usually not associated with a specific etiology

1. Focal

• involve face, upper +/- lower extremities on one side
• " axial structures (neck or trunk) "
• usually associated with focal neuropathology (i.e., cerebral infarction, intracerebral hemorrhage)

2. Multifocal

• involve several body parts and often migrate in a non-Jacksonian (random) manner, may also involve the face
• considered the neonatal equivalent of generalized tonic-clonic seizures
• usually associated the severe generalized cerebral disturbances, i.e., HIE
• clonic movements are rhythmic and slow movements of the limbs (about 1-3 jerks/sec at the onset with the rate progressively declining with the seizure)
• generalized clonic seizures are very rare

1. Focal

• sustained posturing of a limb or asymmetric posturing of the trunk and/or neck

2. Generalized

• "decerebrate posturing"
• "decorticate posturing"
• usually associated with apneas and upward deviation of the eyes
• more common in premies and usually indicates structural brain damage or intraventricular hemorrhage

1. Focal

• involve flexor muscles of an upper extremity

2. Multifocal

• asynchronous twitching of several parts of the body

3. Generalized

• bilateral jerks of flexion of upper & sometimes lower limbs
• rapid movements of distal flexors
• all 3 types may occur during sleep in the newborn
• characterized by brief repeated extension and flexion movements of the arms, legs, or all limbs
• presence suggests severe diffuse brain damage

1. Subtle Seizures

• very few of the clinical episodes are associated with EEG seizure activity
• associated with EEG seizure activity in premies > full-term
• only tonic horizontal deviation of the eyes is consistently associated with EEG seizure activity in full-terms

2. Clonic Seizures

• neonatal seizure most consistently associated with EEG seizure activity
• focal - ictal - unilateral focus of high-amplitude sharp waves adjacent to the Rolandic fissure which can spread to contiguous areas in the same hemisphere
• interictal - focal slowing or amplitude attenuation

3. Tonic Seizures

• Focal - consistently associated with EEG seizure activity
• Generalized - 85% not associated with EEG seizure activity

4. Myoclonic Seizures

• there is a poor association with EEG seizure activity, if present: generalized > focal > multifocal

1. CT/MRI

• especially for clonic (focal) and tonic seizures
• looking for evidence of intracerebral hemorrhages