Neonatal seizures are only a manifestation of a variety of organic, metabolic or functional disorders of the neonatal brain. Most are caused by acute brain insults such as perinatal hypoxic-ischemic encephalopathy, intracranial hemorrhage or CNS infections. Recent years have witnessed a remarkable reduction of simple hypocalcemia, resulting in a relative increase of hypoxic-ischemic encephalopathy. These acute symptomatic seizures are different from epilepsy, a chronic seizure disorder. Most previous studies concerning seizure manifestations of the newborn have dealt with all types of neonatal seizures together, regardless of etiology. It is true that seizures in the neonate pose unique diagnostic and therapeutic problems because of the immaturity of the neonatal brain, but it is not appropriate to study seizure types in the newborn on the basis of acute symptomatic seizures such as those occurring in hypoxic-ischemic encephalopathy in which acute brain swelling or neuronal necrosis may obscure the unique developmental state of the neonatal brain. No one would attempt to classify the seizure types in older children with acute encephalitis and epilepsy together. Such acute symptomatic neonatal seizures should be excluded from the classification of epileptic seizures and syndromes, although they may evolve into symptomatic epilepsy later as a sequel. The current International Classification of Epilepsies and Epileptic Syndromes lists five epileptic syndromes in which neonatal seizures are a major manifestation; benign familial neonatal convulsions(BFNC), benign neonatal convulsion(BNC), early infantile epileptic encephalopathy with suppression-burst(EIEE), early myoclonic enecphalopathy(EME), and neonatal seizures. BFNC and BNC are categorized in idiopathic generalized epilepsies according to the International Classification. BFNC are described as being associated with clonic or apneic seizures, although the ictal EEGs of these seizures have been well documented in only a small number of cases. Seizure types reported to date were partial or generalized. Three of four patients in whom we were able to record ictal EEGs displayed definite partial seizures. One diagnosed as haying generalized seizures did not show typical electroclinical features of generalized tonic-clonic convulsions.
Brain ; Brain Edema ; Child ; Classification ; Electroencephalography ; Encephalitis ; Epilepsy ; Epilepsy, Generalized ; Humans ; Hypocalcemia ; Hypoxia-Ischemia, Brain ; Infant, Newborn ; Intracranial Hemorrhages ; Necrosis ; Neurons ; Seizures*

Currently, there are more than 53,000 beds in kaifukuki rehabilitation wards throughout Japan. The development of kaifukuki rehabilitation wards is proceeding smoothly in terms of quantity. It is suggested that, with this development, the activities of daily living of patients will significantly improve, leading to an increase in the likelihood of patients returning home when a large unit of daily rehabilitation training is provided via one of these kaifukuki rehabilitation wards. The tasks remaining to be completed for the optimal realization of the kaifukuki rehabilitation wards are to reduce the disparity in the number of beds among prefectures, to realize a mature team approach to the rehabilitation program, to encourage full-time ward physicians of the rehabilitation department to exercise leadership, to enhance subacute medical services, to enhance human resources such as nurses and rehabilitation specialists and to improve the education and training system for the staff. Other major tasks remaining are to strengthen the cooperation between kaifukuki rehabilitation wards and acute hospitals, by which such rehabilitation wards will become capable of actively accepting patients from an early stage, and to establish cooperation between kaifukuki rehabilitation wards and the home care system.