Antiseizure medications for neonates with seizures

Abstract

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:1. To assess whether any anti-seizure medication (ASM) is more or less e ective than an alternative ASM (both ASMs used as first-, secondor third-line treatment) in achieving seizure control and improving neurodevelopmental outcomes in neonates with seizures. We will analyse EEG-confirmed seizures and clinically-diagnosed seizures separately. 2. To assess maintenance therapy with ASM compared to no maintenance therapy a er achieving seizure control. We will analyse EEGconfirmed seizures and clinically-diagnosed seizures separately. 3. To assess any ASM treatment compared to no ASM treatment for clinically-diagnosed or only-electrographic seizures.

Sequential levetiracetam and phenytoin in electroencephalographic neonatal seizures unresponsive to phenobarbital: a multicenter prospective observational study in India

“…It is important to note that none of the RCTs of ASM for neonatal seizures have reported neurodevelopmental outcome at 18 months or more. 29 A less effective ASM that leads to a better neurodevelopmental outcome is preferable to a highly effective ASM that adversely affects the neurodevelopment. In the original National Institute of Human Development and Child Health Neonatal Research Network hypothermia trial, 30 ASM medications were associated with adverse outcomes after HIE.…”

Questions and Controversies in Neonatal Seizures

“…Recently, the NEOLEV2 trial (NCT01720667), which is the first randomized controlled trial (RCT) comparing the efficacy and adverse effects of LEV to PHB as first line treatment in neonatal seizures, established that LEV is not as effective as PHB for initial neonatal seizure management [58]. PHB as a first-line treatment is probably more effective than LEV in controlling seizures after the first loading dose and maximal loading dose of ASM [59]. Although more adverse effects have been reported in subjects randomly assigned to PHB compared to LEV, they were not statistically significant [58].…”

Comparative Outcomes of Levetiracetam and Phenobarbital Usage in the Treatment of Neonatal Seizures: A Retrospective Analysis

“…However, translation of these considerations into clinical practice requires rigorous evaluation through randomised controlled trials and observational studies to develop an evidence-based consensus for first-line therapies. A judicious approach that considers the unique pharmacokinetic and pharmacodynamic properties of antiseizure medications in neonates is essential, as underscored by recent meta-analyses which suggest that while newer medications are promising, they are not without their own risks and limitations [7,8].…”