Assymmetric neonatal spasms as an early sign of brain malformation potentially caused by regular light alcohol consumption during the first 22 weeks of pregnancy, a clinical case report

OBJECTIVE: Introduction: Epileptic spasms are seizures usually associated with a severe developmental epilepsy syndrome with onset in the first year of life, peaking between 3 and 10 months of age [12]. A variety of disorders can cause epileptic spasms, with the etiology driving management, prognosis, and overall outcome. Preexisting brain damage has been demonstrated in 60% to 90% of the cases reflecting pre-, peri-, or postnatal brain injury that may usually be determined by history and clinical neurologic examination. Cerebral malformations may account for up to 30% of the cases [2]. Prenatal alcohol exposure can permanently damage the brain, affecting important structures, such as the cerebellum, corpus callosum as well as specific cell populations in many other regions of the brain. No one knows what a "safe" amount of alcohol consumption during pregnancy may be[3]. Objective: The aim of this article is to present a clinical case of a large brain temporal lobe malformation which was recognized after a very early onset of spasms registered on video EEG-monitoring followed by MRI findings and to put forward the assumption that regular consumption of light alcoholic drinks even in low doses could contribute to irreversible brain damage in the fetus. PATIENTS AND METHODS: Material and methods: All patient data were collected from the NICU and Newborn Pathology Department of Lviv City Children's Clinical Hospital Health Record Department, and included the hospital and clinic records by the staff neurologist, neurophysiologist, and pediatrician, as well as EEG records in the postneonatal period. The mother was interviewed to clarify the pregnancy course data. The mother's consent was obtained for publication. RESULTS: Results: Asymmetric spasms, which were recognized as seizures on the 4th day of the child's life while recording video EEG, urged the physicians towards further diagnostic investigations. Primarily the child was diagnosed with neonatal abstinence syndrome on the 2nd day of life based on clinical and patient history data, but on the following day episodes of myoclonic jerks and jitteriness were noticed and video EEG monitoring started. Upon analysis of video- EEG, myoclonic seizures and spasms were reported showing asymmetry in the amplitude of ictal EEG. MRI was recommended and performed to explain focal EEG findings, and a large brain left temporal lobe malformation was seen. CONCLUSION: Conclusions: Spasms in the form of seizures are rarely reported in the neonatal period. Their recognition has to lead to urgent brain imaging study to look for the underlying cause and to implement timely, appropriate corrections in the treatment strategy. Although brain malformations can have many causes, taking careful antenatal, perinatal and family history has ruled out many usual etiologies. Maternal alcohol consumption during pregnancy may potentially have contributed to the condition.

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