From the Guidelines
The workup for seizure-like activity in a 6-week-old male should begin with immediate stabilization of the infant, followed by a comprehensive evaluation, as seizures in this age group often indicate serious underlying conditions, including infections, metabolic disorders, brain malformations, or genetic syndromes, necessitating prompt and thorough evaluation in a pediatric hospital setting with neurological consultation. Initial assessment should include vital signs, glucose measurement, and basic labs including complete blood count, electrolytes, calcium, magnesium, and blood gas analysis, as recommended by the American College of Radiology 1. Lumbar puncture for CSF analysis is essential to rule out meningitis or encephalitis. Neuroimaging with head ultrasound (if fontanelles are open) and/or MRI brain is recommended over CT scan due to radiation concerns, as stated in the ACR appropriateness criteria for seizures in children 1.
Key components of the workup include:
- EEG monitoring to capture and characterize seizure activity
- Screening for inborn errors of metabolism with plasma amino acids, urine organic acids, and ammonia levels
- Genetic testing may be warranted, particularly for conditions like pyridoxine-dependent epilepsy, as suggested by the ACR appropriateness criteria 1
- Empiric treatment may include phenobarbital (loading dose 20 mg/kg IV) as first-line antiseizure medication while the workup is ongoing
- For specific metabolic causes, trials of pyridoxine (100 mg IV), pyridoxal phosphate (30-50 mg/kg/day divided), or biotin (10 mg IV) may be considered. The most common etiologies for neonatal seizures include hypoxic ischemic injury, intracranial hemorrhage, and perinatal ischemic stroke, as reported in a study published in the Journal of the American College of Radiology 1.
From the Research
Workup for Seizure-like Activity in a 6-week-old Male
- The workup for seizure-like activity in a 6-week-old male should include a thorough evaluation to identify and treat the underlying etiology, reducing potential morbidity and mortality 2.
- Laboratory investigations, such as blood and cerebrospinal fluid (CSF) tests, can be fundamental in determining the cause and guiding management of seizures 3.
- Tests should include:
- Electrolytes (e.g., calcium, magnesium, phosphate) to rule out metabolic disturbances 2, 3
- Complete blood count (CBC) and blood culture to rule out infections 3
- Liver and renal function tests to rule out hepatic or renal dysfunction 4
- Creatine kinase (CK) levels to rule out muscle damage or rhabdomyolysis 4
- Imaging studies, such as magnetic resonance imaging (MRI), may be necessary to rule out structural abnormalities or congenital anomalies 5.
- A detailed history, including maternal medical history and medication use during pregnancy, should be obtained to identify potential causes of seizures, such as maternal ingestion of excessive calcium carbonate 2.
- The diagnosis and management of seizures in neonates should follow evidence-based guidelines, such as those developed by the International League Against Epilepsy (ILAE) 6.