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Behavioral Movements

Behavioral movements occur in neurologically normal and abnormal neonates. They are characterized by truncal, facial, and limb movements that occur during sleep or while awake (click on clip).

They consist of hiccups (click on clip), crying, grimaces, sucking, and localized or generalized jerk.

They also include repetitive or erratic and fragmentary movements that represent normal movements that take on unusual qualities because they occur in encephalopathic neonates. They do not produce central nervous system damage or cardiovascular compromise, nor do they have the characteristics of primitive reflexes (fatiguability, spatial and temporal summation, and variability with changes in position). Behavioral movements are not associated with electroencephalographic seizures. Interictal electroencephalographic background activity may be normal or abnormal.

Physiologic Reflex Activity
The Moro reflex, rooting, and sucking are physiological reflexes. They do not warrant any neurological investigations.

Benign Jitteriness
Benign jitteriness is a syndrome that consists of stereotypic movements occurring in a healthy fullterm neonate with normal serum glucose and calcium and no historical risk factors for central nervous system pathology. The movements are characterized by equal, low-amplitude, high-frequency, rhythmic bilateral tremors (click on clip). Benign jitteriness usually occurs in the first two weeks of life. Benign jitteriness can be triggered by stimuli, but may also occur without apparent stimulation. Jitteriness diminishes in response to passive flexion. Benign jitteriness may occur during sleep or quiet awake, but it is especially prominent during crying. Jitteriness can be stopped by restraints. Benign jitteriness has the characteristics of a primitive reflex. Minor increases in heart rate may occur during the event. The EEG background activity is normaland there are no changes during the event.
Neonates with benign jitteriness may be more inattentive and harder to console than other healthy neonates. In the presence of typical findings, it is not necessary to obtain an EEG or imaging study. No treatment is required.



Benign jitteriness most be differentiated disease- associated jitteriness. Benign jitteriness should not be diagnosed in premature neonates or in neonates with neurological or systemic diseases. A systemic condition that should be considered in neonates with jitteriness is Graves disease. Graves disease occurs in infants born to mothers with active or inactive Graves disease or Hashimoto thyroiditis. Graves disease in the newborn period is manifested by jitteriness, irritability, flushing, tachycardia, hypertension, poor weight gain, goiter (Figure 7.1), and exophthalmos.

A B

Figure 7.1. [A] Newborn with Graves disease. [B] Goiter.

 

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Alfonso, 1991 Stockard-Pope, 1993 Lombroso, 1993 normal EEG in fullterm neonates Parker, 1990 Shoper, 1991 Parker, 1990 Smith, 2000 Shuper, 1991