Introduction

At the first International Symposium on Status Epilepticus, held at the University of California, Los Angeles, in 1980, the concept was advanced that neonatal seizures may be either of epileptic or nonepileptic origin, and the clinical and electroencephalographic (EEG) characteristics of each group were described (39). Eventually this work led to the characterization and classification of neonatal seizures based on both clinical features and presumed pathophysiology (40, 54, 55).

Subsequent clinical studies of the neonate by several investigators have resulted in further detailed characterization and classification, clarification of epidemiology, an increased understanding of pathophysiology of various seizure types, identification of trends in risk and etiologic factors, assessment of methods for predicting long-term outcomes, the development of new therapeutic strategies, and ongoing evaluation of the roles of EEG, EEG-video monitoring, and computer-directed, automated EEG seizure detection in diagnosis and management (1, 5, 10, 11, 15, 21, 27, 40, 43, 55, 64, 67, 73, 77, 78, 97).

Although there is now a better understanding of which seizure types may be epileptic in origin, several questions concerning this specific type of neonatal seizure remain unresolved. Two questions in particular are relevant to this discussion: What constitutes status epilepticus (SE) in the neonate? Does this designation have clinical significance for the newborn infant beyond the finding of an epileptic seizure of any duration? These questions are best broached with the understanding that most clinical investigations of neonatal seizures have not distinguished seizures based on pathophysiology, and the seizures have not been described in terms of frequency, duration, or degree of refractoriness to antiepileptic drugs (AEDs). Thus, conclusions about neonatal SE must be drawn from more general studies about neonatal seizures, with recognition of the limitations of this type of analysis.