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The initial clinical assessment of the neonate is pivotal in the differential diagnosis of paroxysmal motor events.
A neonate with paroxysmal motor events with the clinical characteristics of benign neonatal sleep myoclonus, arousals, or behavioral movements do not need laboratory tests, EEG, or brain imaging if they have a normal neurological examination and an unremarkable history.
A neonate with jitteriness, a normal neurological examination, and an unremarkable history requires serum glucose and calcium determinations. If the blood sugar and calcium levels are normal, no further evaluation is needed unless drug withdrawal is suspected. If drug withdrawal is suspected, urine toxicology is required. If urine toxicology is also normal, the diagnosis of benign jitteriness can be made.
Neonate should be admitted and evaluated if they have: (1) paroxysmal motor events without the clinical characteristics of benign neonatal sleep myoclonus, arousal, behavioral movements, or jitteriness; (2) an abnormal neurological examination; or (3) symptoms and signs that place them at risk for seizures. The evaluation includes serum glucose and calcium levels, EEG, and MRI of the brain. The EEG should include provocative maneuvers such as noise, tactile stimulation, and rocking. The provocative maneuvers may trigger the paroxysmal motor event and demonstrate the presence or absence of concomitant electroencephalographic seizures. If an EEG can not be performed, 4-channel continuous EEG monitoring can be initiated by the nursing personnel. Four-channel continuous EEG monitoring is a valuable tool to determine the nature of paroxysmal motor events and correlates well with continuous video-EEG telemetry (Figure 11.1)

Figure 11.1. An electroencephalographic seizure captured by 4-channel EEG monitoring. Sequence of rhythmic discharges.



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Alfonso, 2001 al Naqeed, 1999