Researchers at New York-Presbyterian Hospital, Cornell Medical College, NY, describe 3 (11.5%) sick neonates with stimulus-induced seizure occurring during continuous video-EEG monitoring of a cohort of 26 neonates July-Dec 2007. Duration of video-EEG monitoring ranged from 1-9 days. The underlying brain injury in the 3 infants affected included stroke (n=2) and resolving grade III intraventricular hemorrhage (n=l). Two were full-term neonates and one a 24 week premature. Stroke or hemorrhage followed surgery for congenital heart disorders in 2 infants. Seizures were subclinical in 2 neonates and both clinical and subclinical in 1. Stimuli inducing seizures were physical such as stroking the forehead, changing position, feeding, and endotracheal suctioning. The episodes lasted <1 min. Two infants were neurologically normal at 7 month and 10 month follow-up, and 1, the premature infant with IV hemorrhage, died. This report emphasizes the utility of video-EEG monitoring and the importance of avoiding unnecessary stimuli in neonates with acute neurologic disorders. [1]

COMMENT. Stimulus-induced or reflex seizures are reported in children and adults but are largely unrecognized in neonates. A lack of inhibitory cerebral pathways in immature brain is suggested as a possible cause of abnormal reactivity to sensory stimuli in the neonate. The infants reported had intracerebral pathology that would increase cortical hyperexcitability. Continuous video-EEG monitoring uncovers subclinical or subtle seizures related to sensory stimuli that otherwise would be overlooked. The differential diagnosis includes idiopathic, reflex myoclonic, startle epilepsy (Ricci S et al, 1995), and hyperekplexia with hypertonia and startle reflexes induced by nose tapping, unaccompanied by electrographic epileptic discharges (Dubowitz LMS et al, 1992; Ryan SG et al, 1992).