Diagnosis and classification of neonatal seizures. English version

Abstract Epileptic seizures are the most frequent neurological emergency in the neonatal period. In contrast to seizures in older children and adults they are mostly acute symptomatic seizures as a response to a prenatal or perinatal acute brain injury; less commonly epilepsy is already manifested in the neonatal period. Previous classifications systems were purely based on the clinical observation of behavior despite increasing evidence that the correct diagnosis based on the clinical symptoms is extremely unreliable. In 2021 the Neonatal Task Force of the International League against Epilepsy (ILAE) published a new classification system for neonatal seizures with implications for the clinical management of neonates with presumed or at risk of seizures. This classification emphasizes the importance of electroencephalography (EEG) or amplitude-integrated EEG (aEEG) in making the diagnosis and presumes a predominantly local onset of seizures in the neonatal period. Seizures are classified into motor (automatisms, clonic, epileptic spasms, myoclonic or tonic), nonmotor (autonomic or behavioral arrest), sequential or unclassifiable. Combining clinical observation with EEG or aEEG can help to determine the etiology and ultimately avoid overdiagnosis and underdiagnosis of neonatal seizures with the overall aim to improve the treatment and prognosis of seizures in neonates.