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Movement Arousals
Movement arousals occur in neonates with normal or abnormal neurological examinations. They are characterized by single jerks or briefly sustained postures during sleep (click on clip, below).

They are associated with EEG stage changes or transient flattening of the background activity (click on clip, below).

The periods of EEG flattening may last for up to one minute. These periods of flattening occur more frequently during the first transition from active to quiet sleep and may be bilateral or unilateral. It is important not to mistake this electroencephalographic pattern with those that occur during some electroencephalographic seizures. The interictal electroencephalographic background activity may or may not be normal. No significant changes in cardiac rate occur. They require no treatment.

Marcus Gunn phenomenon
Marcus Gunn phenomenon consists of retraction of the upper lid on opening the jaw (click on clip below). This phenomenon when repetitive and unilateral (as it usually is) may resemble a partial seizure. The clues to the diagnosis of Marcus Gunn phenomenon are that the movements only occurs during feeding or with repetitive mouth opening, and that ptosis of the eye lid is usually present. The retraction of the lid is due to contraction of the levator palpebrae. Contraction of the upper lid while opening the jaw occurs due to aberrant innervation of the levator palpebrae by the external pterygoid portion of the nucleus of cranial nerve V.

 

MALIGNANT PAROXYSMAL MOTOR EVENTS

Convulsions
Convulsions are paroxysmal motor events characterized by increased motor activity that is believed to be a seizure based on clinical observation or proven to be a seizure by its association with an electroencephalographic seizure (click on clip, below).

Convulsions may occur in neurologically normal or abnormal neonates. A paroxysmal motor event is clinically considered a convulsion if it is not triggered by stimulation or stops upon arousal and is characterized by either: (1) focal tonic limb postures; (2) focal or multifocal clonic limb movements; or (3) repetitive facial twitches (click on clip, below).

Nevertheless, many of the events considered to be convulsions based on these criteria are proven not to be so when studied by continuous EEG recording and single photon emission computed tomography.
Any paroxysmal motor event with increased motor activity associated with an electroencephalographic seizure is a convulsion. Convulsions are associated with increased focal hemispheric cerebral perfusion on single photon emission computed tomography. Convulsions can be produced by disorders that require etiologic, antiepileptic treatment, or both.

 

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O'Brien, 1987 Alfonso, 1997