Background
Benign neonatal convulsions are defined as seizures with onset after birth through day 28 in an otherwise healthy child with no other known medical or neurologic problems. Such cases may be familial or isolated. Psychomotor development should be normal for a full-term or near full-term infant with benign convulsions. Between seizures, findings on neurologic examination should be normal. Clinically, the seizures are frequent and brief, occasionally occurring many times within a day. The brief seizures are followed by a short or no postictal state. The episodes usually resolve within days but may continue for several months and have no neurologic sequelae.
The occurrence of status epilepticus is common in benign idiopathic neonatal convulsions (BINC) but is uncommon in benign familial neonatal convulsions (BFNC). Because the condition benign idiopathic neonatal convulsions is a diagnosis of exclusion, it is nearly always made in retrospect, when the seizures spontaneously resolve and the infant is found to have neurologically normal development.
At the outset, considering how broadly to define benign neonatal convulsions is important: for example, whether to include those with myoclonic or partial onset components or those with a known or treatable etiology. Certainly, multiple presentations of seizures that may have a benign long-term outcome are possible in the neonatal period.
Definite advantages exist in approaching the subject from each position. Too broad a definition in a research situation can lead to confusion when searching for a common pathology. Too narrow a definition in the clinical setting may result in confusion about a clinical diagnosis. Later, when the mechanisms are better defined, broader groups not meeting the initial criteria may exist.
Clinically, the more important considerations are taking an appropriate approach to the patient and family, making the correct diagnosis, and pursuing treatment options concordant with the situation. Sometimes, the correct clinical plan may include a decision not to treat a benign condition with medications that often are not so benign. It should also be emphasized that a definitive diagnosis may take some time, given the often retrospective nature of the diagnosis.
For the purposes of this article, myoclonic and partial onset seizures of the neonatal period are considered separate entities; they are mentioned briefly during the discussion on differential diagnosis. See Juvenile Myoclonic Epilepsy, Myoclonic Epilepsy Beginning in Infancy or Early Childhood, Partial Epilepsies, and Complex Partial Seizures for more information on these topics.
For more information, see the following: