Abstracts

Rationale: Some viruses, such as paraechovirus, enterovirus and most recently rotavirus, have been reported to cause neonatal seizures accompanied by diffuse cerebral white matter injury. The purpose of this study was to identify the viral causes of seizures and diffuse cerebral white matter lesions in full-term newborns, and to describe the clinical characteristics.Methods: Twenty-two full-term newborns with seizures accompanied by bilateral diffuse cerebral white matter lesions on diffusion-weighted imaging (DWI) of brain MRI (Fig. 1A) were admitted to our hospital in 2011 and 2012. We retrospectively reviewed the records of 15 of these patients who tested positive for paraechovirus, enterovirus, or rotavirus detection using real-time reverse transcription polymerase chain reaction. Specimens for examination were the stool in 15 patients, serum in 12 patients and cerebrospinal fluid (CSF) in 11 patients.Results: Rotavirus was detected in all 15 stool specimens, but not in the serum and CSF specimens. Paraechovirus and enterovirus were not identified in any specimens. The rotavirus genotype identified in the stool was G4P6 in each of the 15 patients, who were all healthy prior to seizure onset. Their 1- and 5-minute Apgar scores ranged between 7 and 9. The patients age at seizure onset was 4.4 0.7 days (range, 3 6 days) (Table 1). The characteristic findings of their electroencephlaography (EEG) revealed alternations of interhemispherically synchronous or asynchronous bursts of multiple sharp wave discharges, usually with a theta frequency and attenuation of background activity. The EEG findings are consistent with the theta pointu alternant pattern , which is known as the characteristic EEG finding of fifth day fits (Fig. 1B).Conclusions: Rotavirus infection can cause seizures accompanied by diffuse cerebral white matter injury in full-term newborns. The clinical characteristics and EEG findings on patients who experience these seizures suggest that these seizures are fifth day fits.