Seizure Causes in Infants: What You Need to Know

Background Information 

Seizure can be defined as a paroxysmal alteration in neurologic function, which manifests itself as an excessive abnormal and sudden electric activity occurring in the brain. Neonatal seizure (NZ), on the other hand, is the distinctive clinical manifestation of neurological dysfunction in the newborn infant (Hill, 2000). Seizures in neonates vary from those experiences among older infants and adults. They have unique in their pathophysiology, treatment, as well as possible consequences. The most visible signs of neonatal seizure in children include “bicycling motions” and chewing movement. Other common signs include eye deviation, fixed stare, repetitive mount and tongue movements, Apnea, and tonic posturing of limbs, among others. However, seizures among infants are difficult to diagnose clinically due to the close resemblance to a variety of standard, poorly coordinated movements during this brain development stage. 

Seizures among infants are becoming very common, with about 1.8-3.5 per 1000 live births reporting the incidence (Chapman et al., 2012). The prevalence of neonatal seizure increases up to 57.5 per 1000 live births in very low birth weight infants or prematurely delivered babies (Sankar et al., 2010). The prominent causes of seizure among infants, according to recent published studies, include hypoxic-ischemic encephalopathy, hypoglycemia and hypocalcemia, and meningitis (Sankar et al., 2010). Other causes of neonatal seizures are intracranial hemorrhage and developmental defects. The study seeks to investigate the various causes of seizure among infants, and, from the result, recommend more effective diagnosis and treatment methods. 

Problem Statement 

During the neonatal stage of infants, which is the first month of an infant’s life, newborns have high chances of experiencing seizures. The deleterious impacts of neonatal seizures necessitate the need for prompt diagnosis, investigation to determine the cause of the seizure, and subsequent intervention to minimize the possibility of associated cardiorespiratory instability as well as correct the treatable causes. Besides, if not addressed swiftly, seizures might lead to additional cerebral injury that might lead to long-term effects. Currently, there is inadequate data on the primary causes of the various classes of neonatal data. Therefore, the process of diagnosis, treatment, and management of seizures is hampered by the lack of adequate information on the underlying causes of seizure among infants. 

Research Question 

Among the newborn infants, does the cause of seizure within the first 28 days compared with full-grown infants have an impact on their cognitive and developmental abilities later in their adult lives? 

Significance of the Study 

The long-term impacts of seizures in infants is not fully understood by most experts (Kang & Kadam, 2015). Moreover, most experts do not know the causes of seizures in infants (Kang & Kadam, 2015). Seizures are known to bring about developmental and cognitive impairment in infants once they begin growing (Kang & Kadam, 2015). The two forms of impairments can affect the learning and adult lives of the children. It is imperative to have a cognizance of the causes of seizure as it will allow for the prevention of the negative impacts of seizure in the adult lives of the infants. Some of the potential mechanisms of brain injury as a result of repeated neonatal seizures include apnea, elevated blood pressure, increased glycolysis, which might lead to hypoglycemia that exacerbates seizure-induced brain injury. Most of these injuries can be avoided through good intensive care and control of the seizures, and thus the need for the study. 

Objectives of the Study 

To explore the various causes of seizure in infants 

To compare the effects of seizure among neonates and full-grown infants 

Literature Review 

The seizures experienced by infants are very different from those affecting older children. Seizures occur during the first four weeks in full-term infants, also referred to as the neonatal period. Seizures in infants occur because of many factors though there are detectable causes in most children. Seizures have negative long-term impacts on children, such as developmental and cognitive impairments. The aim of this literature review is to highlight explore why the neonatal brain is prone to seizures, to determine the causes of neonatal seizures, and identify the possible effects of neonatal seizures. 

Why Neonatal Brain is Prone to Seizure 

Cases of seizure are prevalent in the first year of life, particularly during the neonatal period. Generally, an infant’s brain is more excitable as compared to the brain of a fully grown person. According to Rakhade & Jansen (2009), the excitability of a neonate can be attributed to the factors including early development of excitatory neurotransmitter systems and relatively delayed development of inhibitors. The higher neural activities as a result of the excitation in an infant’s brain put the developing brain at a greater risk of seizures. Glutamate, which is the central excitatory neurotransmitter in the central nervous system, may lead to seizure in the event that it is produced in higher quantities without the production of ɣ-aminobutyric acid (GABA), which is the major inhibitory neurotransmitter in a mature brain, to counter its effect (Chapman et al., 2012). Since the production of the inhibitory neurotransmitter starts later as compared to excitatory neurotransmitters, infants’ brains are more prone to seizures as compared to the adult brain. 

Strafstrom & Carmant (2015) carried out a literature review on epilepsy and seizures causes carried out by various neuroscientists. The researchers found out that once there is a misbalance between the excitation (E) and inhibition (I) in the brain, seizures are bound to occur. The E/I imbalance is caused by various brain function alterations ranging from neuronal circuits, genes, and cascades in the subcellular signaling. 

Causes of Neonatal Seizures 

Neonatal seizures are rarely spontaneous. Most seizure incidences among infants have underlying etiology. Therefore, the best way to treat neonatal seizures is to first identify the underlying cause to facilitate appropriate intervention and thus enable a better prognosis. 

Developmental Defects 

Although it is rare, cerebral dysgenesis and neuronal migration disorders may lead to seizures among neonates. Carmelo et al. (2019) reviewed the literature to ascertain the cause of epilepsy in children. One of the primary causes of epilepsy in children is seizures. The author also focused on the various risk factors that cause seizures in young children. According to the authors, the key risk factors of seizures in children include alcohol abuse and cigarette smoking during the pregnancy period and premature birth. Children who suffer from brain disorders during the brain development period are also at risk of experiencing seizures. 

Elsewhere, Huijie et al. (2017) carried out a federally funded study to ascertain the impact of a malfunctioning gene that leads to involuntary movement and seizure in infants as early as a few days old. According to the researchers, they found out that GNAO1 (G-Protein Subunit O1) leads to involuntary movements such as NEDIM. The researchers found out that children who suffer from GNAO1 mutations account go a day without convulsions, seizures, and involuntary body movements. The GNAO1 gene is responsible for carrying signals inside the nerve cells from the outside, and thus some of the signals are very strong, thus leading to non-controllable body movements. The following source is credible as the government-funded the research. In addition, the language used in the article is non-inflammatory and unbiased. 

Hypoxic-Ischemic Encephalopathy (HIE) 

Hypoxic-Ischemic Encephalopathy is the main cause of seizures among neonates. About two-thirds of neonatal seizures cases are caused by hypoxic-ischemic encephalopathy (Hill, 2000). In most instances, seizures may be witnessed within the first day of life. seizures are associated with hypoxic-cerebral injuries that might have been sustained during the earlier periods of the pregnancy. Neonatal seizures as a result of HIE are quite difficult to control effective using anticonvulsant medication. In a study conducted by Pisani et al. (2009), to appraise the development of post-neonatal epilepsy among term infants with moderate HIE, 13 participants with moderate HIE, and 5 subjects with severe HIE out of the 92 participants experienced neonatal epilepsy, with 3 of the participants with severe HIE developing epilepsy eventually. 

Michoulas & Farrell (2011) carried out a study to ascertain the cause of afebrile seizures in children. The researchers found out that there are three types of idiopathic epilepsies juvenile myoclonic epilepsy, benign rolandic epilepsy, and absence epilepsy. However, children who suffer from idiopathic epileptic seizures have an epileptic form discharge on electroencephalography. Similarly, the researchers found out that more than half of infants with epilepsy have some form of brain abnormality. 

Metabolism Causes 

Some of the common metabolic causes of neonatal seizures include hypoglycemia and hypocalcemia. Early hypoglycemia and hypocalcemia among infants are as a result of gestational diabetes (Hill, 2000). The conditions might also come about as a result of dehydration, improper fluid administration, and ineffective secretion of ADH. However, with the administration of pyridoxine, the seizures among newborns can be treated. 

Effects of Neonatal Seizure 

The outcome from research that used animals as subjects suggests that seizure during the early infancy period might lead to hypoxia-ischemia induced brain injury (Bjorkman et al., 2010). Seizure in rats resulted in long-term neurological problems. Although multiple studies suggest that neonatal seizure is perilous to immature brains, there is a limited number of research that has used humans as subjects. Nonetheless, there is evidence suggesting a relationship between seizure frequency and the development of cerebral palsy among persons with asphyxia. In sum, exposure to neonatal seizures during the brain development period might eventually lead to complications, including neurological disability and cardiorespiratory instability. 

Based on the literature review above, it is evident that neonatal seizure is a threat to infants’ effective brain development. The high exposure to seizures among neonates necessitates the need to explore the common causes of neonatal seizures among infants during the fast month to facilitate effective diagnosis and prognosis. The references used in the literature review section are all credible, as they have been published in reputable journal sites. The authors of the articles are also competent as they hold qualifications in the medical, while some are successful professionals in the field. 

Design and Methodology 

Population and Sample 

The study will involve 25 to 30 subjects. A purposive sampling method will be employed to acquire participants for the study. To select the participants, a letter will be written to the Pediatrics Associate’s office to request permission to access data for newly diagnosed patients. The Associate’s office will be requested to inform their clients about the research, its objective, and the potential benefits of successfully completing the study (Guillemin & Gillam, 2004). Also, the Pediatrics Associate’s office will also reassure patients about the safety of their personal information. Upon receiving consent from the Pediatrics Associate’s office, and gaining access to the medical data, 40 contacts of newly diagnosed children with seizure will be collected. Afterward, the participants will be provided with a consent form that will provide thorough details about the purpose of the study, the procedure, and how the research team will embrace the confidentiality of their information. At this stage, the potential participants have an option to accept or reject the request to participate in the study. Although 40 contacts will be taken, the research targets between 25 and 30 patients to agree to partake in the study. 

Informed Consent to do the Study 

Before any patient takes part in a study, he or she will be required to go through a participant consent form and provide a signature showing their voluntary decision to participate in the study. Since the research involves children who have not attained the legal age to sign a document, any of their parents or guardians may approve their participation by signing the consent form. 

Participant Consent Form 

Title of the research study: Seizure Causes in Infants 

Investigators : 

Purpose : Based on the national report on newly diagnosed infants with seizures, it is clear that there is a drastic increase in the number of infants diagnosed with seizures. The main purpose of this research is to find the common causes of seizures in infants. 

Procedure : The research will require the patients to respond to some research questions through sit-in interviews as well as questionnaires. 

Alternative Procedures : We request your permission to access your medical data from the Pediatrics Association so that we can evaluate a physician’s report. 

Risks : Answering our questions can make you have some sorrowful memories, and there will be members of the research team to counsel you in the event that it happens. 

Benefits : The benefits of participating in this research is that you will be given procedures of the in-house management of children with seizures. Besides, your children will be given refreshments and playing ground. We also have a baby care program during those days for your children, so you can come with them. 

Data Collection and Storage : The information you have provided during the interview will be inserted into our cloud data system (SPSS), where we will analyze the data too. After the information has been keyed into our system, we will discard the papers by burning them in our kiln. 

Contact Information : For any concerns or inquiries relating to your rights, contact our information technology team through ………………………………. 

Consent Statement : I have clearly read and understood your procedures. You have responded to all my questions. I understand that I am free to quit my participation. I confirm that I will participate in your study. 

Signature of the Subject: _________________________________ 

Date _________________________________________________ 

Signature of Investigator _________________________________ 

Date _________________________________________________ 

Data Collection Procedure 

The study will use qualitative methods of data collection. Participants will be required to fill in questionnaires. The questionnaires will incorporate both open-ended and closed-ended questions. To facilitate a smooth process of responding to these questions, a researcher will always be present whenever patients are filling in the questions. The team will respond to any inquiries during the process of filling in the questionnaire. Direct interviews will be the other data collection method used. The research team will sit with the participants and ask direct questions. The responses will be recorded using a sound recorder for future reference. Finally, in addition to questionnaires and interviews, the research will also incorporate patients’ medical records. Upon the approval of the Pediatrics Associate’s office and the participants, the medical records will be collected for analysis. 

Project Data Analysis 

Definition of Variables 

The independent variables that will be used in the study include gender, gestational age, the weight of the child (in grams and kilograms). Other data that will be collected include the genetic structure of the mother, as well as the gestational history. The depended variable for the study will be the frequency of the seizures in the participating infants, and the type of seizures. Seizures will be classified into infraclinical, focal, tonic-clinical, clonic, subtle, spasms, and myoclonic seizures. 

Research Hypothesis 

Null hypothesis : There is no statistical relationship between brain infections and seizures in children. 

Alternative hypothesis : There is a significant statistical relationship between brain inflammation/infections and the frequency of seizures in infants. 

Method of Data Analysis 

The SPSS software will be used for all analyses. For the purposes of comparing qualitative variables, a fisher and chi-square test will be performed (Ghesemi & Zehediasl, 2012). The Student’s T-test will be used to determine the mean values for numeric variables, and a significance level will be set at 0.05. A multivariate analysis will be employed since this study analyzes the relationship between several variables. 

To reject the null or research hypothesis, the value of P will be evaluated, such that if P is than or equal to the level of significance, α, then the null hypothesis is rejected and the alternative hypothesis is accepted (PennState Eberly College of Statistics, 2019). Alternatively, if P is greater than α, then the null hypothesis is not rejected. 

Ethical Considerations in the Study 

While collecting data, especially data that requires participants’ confidential information like health status, the researchers must ensure that they embrace ethical standards to ensure that personal information does not leak. Since the research requires access to patients’ information, the research team must ensure that the study embraces high ethical standards (World Medical Association, 2011) 

First, the research team will conduct a review of all related ethical policies, procedures, and practices for health research. The team will also conduct a review of human rights related to health-information confidentiality. As such, the research team will have full information on what is required to conduct the study within the set ethical standards of the policies (Guillemin & Gillam, 2004). Second, the study will also have its sets of ethical standards that give rewards and punishments to members of the research team who maintain ethical standards and those who break them, respectively. The research team members will, therefore, ensure that they do not commit offenses that might lead to punishments. Finally, an ethical team will be set up to act as a watchdog and an implementer. The team will take up the role of ensuring that the set ethical standard is followed strictly. There will be emergency contacts that the research participants can use to report any form of misconduct and violation of the ethical standards at any time. The team will then investigate and respond to the human rights violation allegations accordingly. 

References 

Andersen, S., L., Laurberg, P., Wu, C.S., & Olsen, J. (2013). Maternal thyroid dysfunction and risk of seizure in child; a Danish nationwide cohort study, Journal of pregnancy,2013. 

Björkman, S. T., Miller, S. M., Rose, S. E., Burke, C., & Colditz, P. B. (2010). Seizures are associated with brain injury severity in a neonatal model of hypoxia-ischemia.  Neuroscience ,  166 (1), 157-167. 

Chapman, K. E., Raol, Y. H. & Brooks‐Kayal, A. (2012). Neonatal seizures: controversies and challenges in translating new therapies from the lab to the isolette.  European Journal of Neuroscience ,  35 (12), 1857-1865. 

England, M.J., Liverman, C, T, Schultz, A, M., &Strawbridge, L. M. (2012). Epilepsy across the spectrum: Promoting health and understanding: A summary of the Institute of Medicine report. Epilepsy & Behavior, 25 (2), 266-276. 

Feng, H., Sjorgren, B., Karaj, B., Shaw, V., Gezer, A., & Neubig, R, R. (2017). Movement disorder in GNAO1 encephalopathy associated with gain-of-function mutations, Neurology, 89(8), 762-770. 

Ghesemi, A., & Zahediasl, S. (2012). Normality test for statistical analysis: a guide for non-statisticians. International journal of endocrinology and metabolism, 10 (2), 486. 

Gill, P., Stewart, K., Treasure, E., & Chadwick, B. (2008). Methods of data collection in qualitative research interviews and focus groups. British Dental Journal, 204 (6), 291. 

Guillemin, M., Gillam, L. (2004). Ethics, reflexivity, and “ethically important moments” in research. Qualitative inquiry , 10 (2), 261-280. 

Hill, A. (2000). Neonatal seizures. Pediatrics in Review 21 (4), 117-121. 

Macleod, S., & Appleton, R.E. (2007). Neurological disorders presenting mainly in adolescence, Archives of disease in childhood, 92 (2), 170-175. 

Michoulas, A., Farrell, K., & Connolly, M. (2011). Approach to a child with a first afebrile seizure, BCMJ, 53, 274-7. 

Minardi, C., Minacapelli, P. (2019). Epilepsy in children: from diagnosis to treatment with a focus on emergency, Journal of clinical medicine, 8 (1), 39. 

PennState Eberly College of Statistics. (2019). S.3.2 Hypothesis Testing (P-Value Approach). Retrieved from https://newonlinecourses.science.psu.edu/statprogram/reviews/statistical-concepts/hypothesis-testing/p-value-approach 

Pisani, F., Orsini, M., Braibanti, S., Copioli, C., Sisti, L., & Turco, E. C. (2009). Development of epilepsy in newborns with moderate hypoxic-ischemic encephalopathy and neonatal seizures.  Brain and Development ,  31 (1), 64-68. 

Rakhade, S. N., & Jensen, F. E. (2009). Epileptogenesis in the immature brain: emerging mechanisms.  Nature Reviews Neurology ,  5 (7), 380. 

Sankar, J. M., Agarwal, R., Deorari, A., Paul, V. K. (2010). Management of neonatal seizures. The Indian Journal of Pediatrics, 77 (1), 1129-1135. 

Stafstrom, C. E., & Carmant, L. (2015). Seizures and epilepsy: an overview of neuroscientists. Cold Spring Harbor perspective in medicine, 5 (6), a022426. 

World Medical Association. (2011). World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bulletin of the World Health Organization, 79(4), 373.