Jitteriness is a common movement phenomenon in the newborn period. If there are other concurrent manifestations, such as eye opening, eye deviation, mouth movements, tachycardia, or hypertension, an ictal etiology should be suspected. Since apnea may also be an important sign of neurologic diseases such as hypoxic-ischemic encephalopathy, intraventricular hemorrhage, infections, hypoglycemia, and medication side effect, an extensive search for an underlying etiology should be undertaken. Apnea may occur in the older infant and present as an acute life-threatening event. ![]() ![]() This "apnea of prematurity" is likely to be secondary to brainstem immaturity and is typically associated with bradycardia (A's and B's). Apnea occurs commonly in the premature child, especially during active sleep. Apnea may be secondary to centrally mediated hypoventilation or an obstructive etiology. Age ranges are somewhat arbitrary, and some of the nonepileptic events that have been classified under infancy may begin in the newborn period.Īpnea, or cessation of breathing for greater than 15 seconds, is usually not due to an epileptic seizure, particularly if apnea is the sole manifestation, and the patient has not been already treated with anticonvulsant medication. Other specific nonepileptic events are described below. Some examples of common nonepileptic paroxysms include nonconjugate eye movement, sucking movements without associated eye abnormalities, and nocturnal myoclonus. Subsequent review of the tapes can help to establish the correct diagnosis, and may also be used to reassure apprehensive parents. When attacks recur frequently, parents can be asked to videotape the events. First-time parents may not be familiar with the character of these movements. ![]() Newborns also exhibit a variety of periodic normal movements that can be readily identified by experienced observers as being nonepileptic. These events may reflect brainstem-release phenomena (therefore, nonepileptic events) or may represent subcortical epileptic seizure activity. As discussed, some clinical events such as "subtle seizures," generalized tonic, and focal/multifocal myoclonic events, do not necessarily have an EEG correlate.
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