Introduction:

Seizure is described as a paroxysmal behavior caused by hyper synchronous discharge of a group of neurons¹. Neonatal seizures refer to the paroxysmal activity occurring in first 28 days of life or up to 44 weeks conception age in an infant². They are often the first sign of neurological dysfunction in neonates³.

Neonatal seizures occur in 80-120 cases per 100,000 neonates per year and the highest incidence is in first 10 days of life¹. The underlying pathology is diverse and determines the immediate and long term outcome in terms of developmental impairment. It includes hypoxic ischemic encephalopathy, intracranial hemorrhage, infections and metabolic abnormalities. Determining the underlying etiology is critical and delay in treating the inciting pathology may adversely affect the final outcome. Western literature shows higher incidence of seizures related to hypoxic ischemic encephalopathy (65%) and intracranial hemorrhage (10%)^3,4. Repeated neonatal seizures lead to further brain injury. The probable mechanisms include hypoventilation causing further hypoxic injury, hypercarbia increasing cerebral blood flow with risk of intracranial hemorrhage, increased glycolysis causing hypoglycemia and excitatory amino acids causing excitotoxic brain injury. The etiology of neonatal seizures varies with socioeconomic environment and health facilities available. Pakistani studies point towards CNS infections (40 - 45.2%) and birth asphyxia (40 – 56%) being more common^{5, 6}. The duration of treatment and outcome also depends on the underlying cause⁷. Only limited studies are available regarding the outcome of the neonatal seizures according to the underlying pathology in developing countries like Pakistan.

In this study, I aim to determine the frequency of various etiological factors responsible for neonatal seizures at a tertiary care hospital in Lahore, Pakistan. Immediate outcome related to these underlying pathologies and outcome at 2 month and 4 months regarding seizure control as well as developmental and neurological deficits will be studied. It will help to establish the profile of etiological factors causing neonatal seizures in our set up and explain the prognosis more accurately.