Case 5.1

An infant was born at 41 weeks gestation by uncomplicated vaginal delivery. Apgar scores were 9, 10, and 10 at 1, 5, and 10 minutes, respectively. The infant was doing well at birth, with an umbilical artery pH of 7.28. At 12 hours of age, the baby developed clonic movements of the right arm. You connected the baby to the aEEG, which showed the following:

What markers from A to G are seizures?

Raw EEG of Markers A, E, and G is demonstrated below:

Also demonstrated in the video:

The baby was treated with phenobarbital (C and G), midazolam and lidocaine

Note that especially the upper margin is irregular prior to lidocaine administration and this changes after administration of this ASM.

What do you think is the most likely diagnosis?