title: The puzzle of apparent life-threatening events in a healthy newborn.
abstract: Apneic neonatal seizures can present as apparent life-threatening events. We report a newborn with unexplained episodes of apnea associated with cyanosis and desaturation, starting on the first day postpartum. Biochemical tests were normal. Central nervous system infections as well as abnormalities of upper airways and cardiovascular system were excluded. Brain monitoring using amplitude-integrated electroencephalography (aEEG) was inconclusive. Continuous monitoring using video EEG revealed epileptic seizures originating from the left temporal region as the cause of the apneas. Magnetic resonance imaging (MRI) of the brain showed a developmental malformation of the left frontal and temporal lobes. The patient became seizure free after treatment with antiepileptic medication. This report illustrates that brain monitoring using amplitude-integrated EEG alone could miss focal neonatal seizures. When clinical suspicion of apneic seizures is high in infants with apparent life threatening events, multichannel polygraphic video-EEG monitoring is indicated. Prompt diagnosis and treatment can be life saving.
authors.affiliation: Section of Clinical Neurophysiology, Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Ladbon
authors.initials: L
authors.lastname: Khajeh
authors.affiliation: Section of Clinical Neurophysiology, Department of Neurology, Erasmus MC, Rotterdam, The Netherlands j.perumpillichira@erasmusmc.nl.
authors.forename: Perumpillichira J
authors.initials: PJ
authors.lastname: Cherian
authors.affiliation: Section of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Renate M
authors.initials: RM
authors.lastname: Swarte
authors.affiliation: Section of Pediatric Neurology, Department of Neurology, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Liesbeth S
authors.initials: LS
authors.lastname: Smit
authors.affiliation: Department of Pediatric Radiology, Erasmus MC-Sophia, Rotterdam, The Netherlands.
authors.forename: Maarten H
authors.initials: MH
authors.lastname: Lequin
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D020182:Sleep Apnea, Central / Q000150:complications* / Q000523:psychology*
keywords: EEG; amplitude-integrated EEG; apneic seizures; neonatal