Seizures during the neonatal period may be the result of of a subarachnoid hemorrhage. Focal seizures often are the multiple causes, with characteristic historical and clini-result of local cerebral infarction. cal manifestations. Seizures caused by hypoxic-ischemic Seizures may be difficult to differentiate from benign encephalopathy (postasphyxial seizures), a common cause jitteriness or from tremulousness in infants of diabetic of seizures in the full-term infant, usually occur 12 to 24 mothers, in infants with narcotic withdrawal syndrome, hours after a history of birth asphyxia and often are refrac-and in any infants after an episode of asphyxia. In contrast tory to conventional doses of anticonvulsant medications. to seizures, jitteriness and tremors are sensory dependent, Postasphyxial seizures also may be caused by metabolic elicited by stimuli, and interrupted by holding the extremdisorders associated with neonatal asphyxia, such as hypo-ity. Seizure activity becomes manifested as coarse, fast and glycemia and hypocalcemia. Intraventricular hemorrhage slow clonic activity, whereas jitteriness is characterized (IVH) is a common cause of seizures in premature infants by fine, rapid movement. Seizures may be associated with and often occurs between 1 and 3 days of age. Seizures with abnormal eye movements, such as tonic deviation to one IVH are associated with a bulging fontanelle, hemorrhagic side. The electroencephalogram often shows seizure activspinal fluid, anemia, lethargy, and coma. Seizures caused by ity when the clinical diagnosis is uncertain. Identifying hypoglycemia often occur when blood glucose levels decline seizures in the newborn period is often difficult because to the lowest postnatal value (at 1 to 2 hours of age or after the infant, especially the low birth weight infant, usually 24 to 48 hours of poor nutritional intake). Seizures caused by does not show the tonic-clonic major motor activity typical hypocalcemia and hypomagnesemia develop in high-risk of the older child (Table 64-1). Subtle seizures are a com-infants and respond well to therapy with calcium, magne-mon manifestation in newborns. The subtle signs of seizure sium, or both. activity include apnea, eye deviation, tongue thrusting, eye