Abstracts

Rationale: Apnea and desaturation episodes in neonates and infants usually trigger multiple investigations. Seizure is often considered as a differential diagnosis. Apnea as an isolated seizure manifestation is rare. However, there are reports of temporal lobe pathologies in neonates presenting as isolated apneic seizures. Aim: We describe the results of long-term video EEG in neonates and infants that were referred to rule out seizures. Methods: Video EEG data base of the McMaster Children s Hospital was used to identify patients. Inclusion criteria: 1. Neonates and infants (<1 year) who had at least one prolonged video EEG during March 2008- May 2011. 2. Primary reason for referral was apnea and or desaturation episodes. All the tracings were re-analyzed. A data abstraction form was used to collect demographic information, clinical findings, and imaging and v-EEG findings. Results: During this period 32 patients (<1 year) had prolonged Video EEG. 15 patients (9 days to 9 months) were referred for evaluation of apnea and or desaturation episodes. 11 (11/15) patients had no abnormal movements accompanying apneic/desaturation events. At least one typical event was captured during the v-EEG in 12 patients. In 5 patients (5/12) apnea/desaturation was associated with electrographic seizure pattern. One patient had tonic movement and two had very subtle clonic movements as well. Two patients were diagnosed to have benign familial neonatal convulsion. One patient had secondary anoxic electrographic seizure during breath holding. Aetiology seizures in two patients (one with kern icterus and another with low muscle tone) is unclear.Conclusions: In a selected group of neonates and infants with apnea/desaturation episodes, seizures were not uncommon (42%). Apnea could be the isolated seizure manifestation as well. Benign neonatal convulsion is a possibility in non-encephalopathic infants.