Abstract: Neonatal convulsions, which are defined by abnormal, involuntary movements in infants, are a serious neurological issue that needs to be diagnosed and treated as soon as possible.Neonatal seizures can have a variety of causes, including structural brain disorders, infections, and metabolic issues and anomalies and hereditary illnesses. There is growing interest in homeopathy as a holistic approach to treating neonatal convulsions, with an emphasis on customised remedies that address the patient’s constitutional state and stimulate the body’s healing mechanisms. Early detection of seizures is essential because delayed treatment can cause long-term neurological deficits. To enhance general well-being and quality of life, homeopathic treatment takes into account each patient’s particular symptoms, potential underlying causes, concurrent symptoms, and mental and physical predispositions.
Keywords: homeopathy, holistic approach, customized treatments, quality of life, neonatal care, convulsions in newborns
Introduction: A seizure is a brief episode of symptoms brought on by excessive or synchronous abnormal brain neuronal activity.1 A neurological condition is indicated by seizures in newborns. It is the clearest sign of neurological issues in a newborn, so identifying neonatal seizures, figuring out their cause, and treating them are crucial.
Difference between convulsion, Seizures and epilepsy-
SEIZURE– It is described as a paroxysmal involuntary disruption of brain function that can show up as abnormal motor activity, behavioural abnormalities, sensory disturbances, autonomic disturbances, or impairment or loss of consciousness.1
CONVULSION – In particular, convulsion describes the visible motor activity (like jerking or shaking) that frequently occurs during a seizure, especially in generalised tonic clonic seizures.Convulsions are usually regarded as a form of seizure’s physical manifestation rather than a distinct condition.
EPILEPSY– Two or more unprovoked seizures that happen more than twenty-four hours apart and have no apparent cause are considered epilepsy.7
Incidence of Neonatal Convulsion
- Incidence increase with decreasing gestation and birth weigh
- 10.3 per 1000 live birth
- Preterm incidence- twice as compared to term- 20.8 per 1000 live birth
Types of Seizures:
- Epileptic seizures- Clinical conditions like clonic seizures that are linked to corresponding electroencephalogram (EEG) seizure activity.
- Non epileptic seizures – Clinical seizures, such as subtle and generalized tonic seizures, do not correlate with an EEG.
EEG seizures – Abnormal EEG activity with no clinical correlation.
Seizures can be provoked or unprovoked.
Provoked Seizures- Provoked seizures can happen after a fever, electrolyte imbalance, brain disorders involving structure, inflammation, or metabolism, infections like meningitis or encephalitis, or a stroke. It is crucial to understand that provoked seizures do not progress to epilepsy and frequently get better with therapy of the underlying cause, and they don’t need long-term anti-epileptic medications.
Pathophysiology–
The brain needs to continuously strike a balance between excitation and inhibition in order to respond to its surroundings and prevent unchecked spontaneous activity. Gamma-aminobutyric acid is a crucial inhibitory transmitter that acts on ion channels to decrease the likelihood of action potential formation and increase chloride inflow. Glutamate and aspartate, two excitatory amino acids, permit the entry of calcium and sodium, which has the opposite effect. An imbalance between this excitation and inhibition is probably the cause of a large number of seizures.2
Excitatory neurotransmitters in relative excess
Inhibitory neurotransmitter deficit
Etiology –
- Intracranial haemorrhage (Hypoxic ischemic encephalopathy)
- Neonatal tetanus
- Meningitis
- Sepsis
- Inborn errors of metabolism
- Birth asphyxia
- Birth trauma
- Developmental defect
- Hypocalcaemia
- Hypoglycemia
- Kernicterus
Correlation of Time of Onset of Seizures and Aetiology
| Most Frequent Time | Aetiology of Seizures |
| < 48 Hrs. | Hypoxic – Empirical encephalopathy Internal hemorrhage in the brain
Hypoelectrolytemia and Hypoglycemia Viral infections that are congenital Induced by Drugs The Dependency on Pyridoxines Non ketotic Elevation cycle of urea chaos |
| 48-72 Hrs. | Cerebral dysgenesis, Early sepsis, Urea cycle disorder |
| 7 days | Organic acidemias, Amino acidopathies, Bacterial meningitis, BFNC and BINS |
Seizures are frequently confused with normal neonatal motor activity.
➢ AWAKE or DROWSY
- Unsustained, Sucking, Puckering
- Nystagmoid jerks
- Roving eye movements
➢ SLEEP
- Generalized, isolated myoclonic jerks in response to arousal
- Myoclonic fragmentary jerks
Types of Seizure
- Subtle Seizures
- It consists 50% of all neonatal seizures
- autonomic: High heart rate and blood pressure in premature babies
- Extremities- Stepping motions of the autonomic
- Motor: Boxing, Hooking, Rotary Pedalling,
- Apnoea Full Term? Premature
- Oral: -Chewing, Drooling, Sucking, Laughing
- Eyes Blinking, Sustained Opening, Ocular Movements, : Tonic Horizontal Deviation
- Myoclonic Seizures
- Myoclonic jerks are generally distinguished from clonic movements by their greater speed, lack of slow return, and preference for flexor muscle groups. They can involve one or more lightning-fast jerks of the upper or lower limbs.
- EEG changes- focal sharp waves
- 15-20% of neonatal seizures.
- Typically, not repetitive or may recur at a slow rate
- Random, single, rapid contractions of muscle groups of the limbs, face or trunk
- Clonic Seizures
- It consists of 20-30% of neonatal seizures. Focal and multifocal
- Consciousness may be preserved
- Signals focal cerebral injury
- Clonic movement are rhythmic and slow movements of limbs (about 1-3 jerks / at the onset and lateral declines
- Tonic Seizures-
- 5% of neonatal seizures
- Both focal and generalized tonic seizures are possible.
- Focal seizures are characterized by a persistent horizontal eye deviation and limb or trunk posture.
- Bilateral tonic limb extension or tonic flexion of the upper extremities combined with tonic extension of the lower extremities are symptoms of generalized seizures.
- Asymmetrical posture of the trunk and/or neck, or prolonged posture of a limb: The decerebrate posture Decorticate posture
- Most common in preemies and usually indicates structural brain damage and IVH
- Spasm- Usually accompanied by a single, extremely brief, widespread discharge, sudden generalized jerks last 1-2 seconds.
- Absence Seizures- Short periods of inactivity followed by prolonged staring (3–30 seconds), typically brought on by hyperventilation
Seizure Mimics– Jitteriness or Tremors
These are the most prevalent conditions that cause seizures in newborns. We refer to these as rhythmic segmental myoclonus. They are frequently observed in hypoglycemia, hypocalcemia, and in certain healthy newborns. These characterized fast, rhythmic movements (4-6/s) are triggered by stimuli related to pulling the hand or leg gently or by triggering the Moro reflex or startle These have nothing to do with abnormal eye movements or other changes in the autonomic nervous system or EEG.
Clinical Characteristics Which Distinguish Jitteriness From Seizures Clinical Features
| SEIZURES | JITTERINESS | |
| Quality of Movement | Clonic Jerking | Tremor |
| Associated Abnormal Eye Movements | + | 0 |
| Movements Cease with Restraint | 0 | + |
| Stimulus – Sensitive Movements | 0 | + |
Healthy Sleep for Newborns Although the exact cause of myoclonus-nonepileptiform myoclonus is unknown, it might be connected to a temporary deficiency of the brainstem reticular activating system. Typically, it appears during the first week of life. It only happens while you’re sleeping, and arousal quickly eliminates it. It can also caused by tactile stimuli or soft, rhythmic rocking. In this condition, the EEG is normal. It goes away on its own in a matter of weeks to months. Epilepsy does not develop later, and the long-term results are favourable. Because barbiturates exacerbate this condition, early diagnosis is crucial.
Diagnosis History
- Genetic syndrome may be suggested by family history.
- A lot of these conditions are harmless.
- If there are no other causes, a family history of seizures may indicate a favorable prognosis.
- Antenatal history is crucial. Past medical history of maternal infections, diabetes, preeclampsia, or fetal distress
- Delivery history- Type of delivery and antecedent events
- Apgar scores offer some guidance
- There is little chance that a low Apgar score without the need for resuscitation and subsequent neonatal intensive care will be linked to seizures in newborns.
Approach To Diagnosis Of A Neonate With Seizure7
| Neonatal period (birth to 28 days) |
| Age: the existence of risk factors; and important family, developmental, and birth histories | What to think first? |
| Past medical history of meconium-stained liquor, prolonged labor, instrumental delivery, delayed crying, perinatal asphyxia, and prolonged ventilation | Birth asphyxia, hypoxicischemic injury, intracranial bleed |
| Prematurity, maternal diabetes, and birth asphyxia history | Metabolic disorders like hypocalcemia hypoglycemia |
| History of pathological jaundice | Bilirubin encephalopathy (Kernicterus |
| Consanguinity history, miscarriages, recurrent abortions, unusual urine odor, and inexplicable fatigue. getting worse after starting feeds | Inherited disorders of metabolism like urea cycle disorders, aminoacidurias, organic acidurias |
| Small head or abnormal looking facial features, other congenital anomalies | CNS malformations |
| Past medical history of excessive
sluggishness, refusal to eat, rapid breathing, reduced feeding, and irregular movements |
Sepsis, meningitis |
Investigation – • Ultrasonography and CT scan of head: To identify intraventricular or subarachnoid haemorrhage
- EEG: The primary diagnostic tool Finding an epileptic focus, confirming a clinically doubtful convulsion, and figuring out its anatomical basis are all helpful.
- Blood biochem.->evaluation of Glu, Ca, Mg, electrolytes -Blood gas levels to detect acidosis & hypoxia
- Lab studies- Blood count, urine & CSF culture -Serum IgM & IgG-specific TORCH titres Treatment Protocol
- To control convulsions
- To treat the underlying pathology
Prognosis-
- Vary according to the aetiology
- The prognosis for hypercalcemic convulsions is very good.
- About 30–40% of neurological sequelae still exist.
How to handle a case of compulsive behavior using homeopathic remedies: –
Homeopathic Approach-
- Absinthium: -The patient trembles before the convulsions, makes grimaces, bites their tongue, and foams their mouth. Particularly useful when there is mild epilepsy and some residual consciousness. [3]
- Artemisia Vulgaris: A treatment for childhood convulsive diseases, epileptic disorders, and puberty in girls. epilepsy with a slight malformation. There is no aura. Frequent, brief seizure episodes that occur quickly are the primary symptom. Strong emotions are what cause the seizure to occur.including anxiety. [3]
- Bufo Rana: –seizures caused by epilepsy that occur while you’re asleep. The genital area is where the aura is felt. It also works well for women who experience seizure attacks during their periods. Young people experience headaches after attacks brought on by onanism or during coition. [3]
- Belladona: – Attacks of epilepsy that are followed by vomiting and nausea. The arm is where the convulsions start. Prolonged unconsciousness follows spasms. serves as a preventative measure against scarlet fever
- Plumbum Metallicum: – persistent epilepsy, accompanied by hemorrhages and a noticeable aura
- Stramonium: – where exposure to bright light or shiny objects causes the convulsion. Convulsions of a single muscle group and upper extremities occur, but consciousness is maintained.
- Hyoscyamus: – when an epileptic episode is followed by deep sleep. Other symptoms include twitching of the muscles, playing with the hands, and picking at the bed linens.
Reference
- Gupta, P., Menon, P., Ramji, S., & Lodha, R. (2015). PG Textbook of Pediatrics: Volume 1: General Pediatrics and Neonatology. JP Medical Ltd
- Ralston, S. H., Penman, I. D., Strachan, M. W. J., & Hobson, R. (2018). Davidson’s Principles and Practice of Medicine E-Book: Davidson’s Principles and Practice of Medicine E-Book. Elsevier Health Sciences
- Boericke W. Pocket manual of homeopathic materia medica & repertory. New Delhi, India: B Jain; 2023.
- Kent, J. T. (1989). Lectures on Homoeopathic Materia Medica: Together with Kent’s “New Remedies” Incorporated and Arranged in One Alphabetical Order. B. Jain Publishers
- Phatak, S. R. (1999). Materia Medica of Homoeopathic Medicines. B. Jain Publishers
- Nelson WE, editor. Nelson textbook of pediatrics. 16th ed. London, England: W B Saunders; 2000.
- Gupta, P. (2019). Clinical Methods in Pediatrics. CBS Publishers & Distributors Pvt Limited, India
Authors
Dr. Prasoon Choudhary1, Dr. Kamal Nainawat2, Dr. Tushar Agarwal3
1 HOD, Dept Of Paediatrics, Dr. M.P.K. Homeopathic Medical College, Hospital and Research Center(Constituent College of Homoeopathy University), Jaipur, Rajasthan, India
2,3 PG Scholar, Dept Of Paediatrics, Dr. M.P.K. Homeopathic Medical College, Hospital and Research Center(Constituent College of Homoeopathy University), Jaipur, Rajasthan, India
