Management of refractory neonatal seizures

Neubauer, David; Soltirovska-Šalamon, Aneta; Osredkar, Damjan; Paro–Panjan, Darja

doi:10.2147/rrn.s39714

Cited by 3 publications

(1 citation statement)

References 110 publications

(149 reference statements)

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“…However, combination therapy was found to be superior to single drug therapy. 13 According to another study they compared 5 different drugs for fits controlsw2 in non syndromic epilepsy and it was noted that the most commonly prescribed and efficacious drug was Levitriacetam and was noted in 74% of the cases with p= 0.001. 14 `Medical crises requiring immediate and proper anticonvulsant treatment include tonic-clonic convulsions and convulsive status epilepticus (now defined as a tonic-clonic convulsion lasting at least 30 minutes).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Levetriacetam and Phenytoin as Combination Therapy in Infants Presented with Status Epilepticus

Liaqat¹,

Khalid²,

Khan³

et al. 2022

PJMHS

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Levetiracetam may be an effective and safer alternative to phenytoin as a second-line intravenous anticonvulsant for the treatment of juvenile convulsive status epilepticus. Objective of this study was to determine the efficacy of Levitriacetam and Phenytoin as combination therapy in infants presented with status epilepticus. Material and Methods: In this cross observational sectional study (01-02-2020 to 31-07-2020) at department of pediatrics mayo hospital Lahore. study the infants were enrolled of either gender and age less than 1 year that were suffering from a seizure with 5 minutes or more of continuous clinical seizure activity or recurrent seizure activity without recovery between seizures.Then these cases were started with both Phenytoin (Loading: 15 - 20 mg/kg IV *Maintenance: 5 - 8 mg/kg/d) and Levitriacetam (Loading dose5 10 mg/kg IV and Maintenance dose 10 – 30 mg/kg/dose q12 hours ) and were observed daily to look for fits. Efficacy was labelled as yes where there were no fits for 48 hours after the treatment. Results: In this study there were total 120 cases and out of these 74 (61.67%) were males and 46 (38.33%) females. Mean age of the subjects was 4.57±3.97 months. Mean duration of symptoms was 2.23±1.47 days. Out of 120, tonic clonic seizures were noted in 78 (65%) of the cases and 30 (25%) of the cases had family history of epilepsy. Efficacy was noted in 84 (70%) of the cases. Conclusion: Combination of Levetriacetam and Phenytoin is highly efficacious in infants presented with status epilepticus. Keywords; Levetriacetam, Phenytoin, Status epilepticus, Fits, Infantile seizures

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Section: Discussionmentioning

confidence: 99%

Efficacy of Levetriacetam and Phenytoin as Combination Therapy in Infants Presented with Status Epilepticus

Liaqat¹,

Khalid²,

Khan³

et al. 2022

PJMHS

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Refractory Seizures of Infancy with SCN2A: A Case Review

Sutton¹,

Carlson²,

Riley³

2019

Neonatal Network

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Neonatal epilepsy occurs for many reasons. Infants may present shortly after birth with seizure activity or seizures may occur later in the neonatal period. Seizures that are refractory to treatment can be difficult to manage and because of different presentations, there may be a delay in diagnosing the exact etiology. Prompt intervention is necessary and developing a plan of care can be done while exploring the etiology. There are several genetic mutations, including the SCN2A sodium ion channelopathy, that can result in a wide array of epileptic conditions, ranging from mild to severe. This case review focuses on diagnosis and management of SCN2A refractory seizures.

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Case Report: resolution of refractory seizures after neurosurgical intervention in newborns with cerebral extra-axial hemorrhages

Rohaert,

Spoor,

Dremmen

et al. 2024

Front. Pediatr.

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IntroductionIntracranial hemorrhage is a significant cause of neurological damage in newborns. Extra-axial hemorrhages with intraparenchymal extension can precipitate acute clinical deterioration. Seizures are one of the presenting symptoms, which can be refractory to treatment. These hemorrhages can result in considerable long-term morbidity and mortality.AimThe objective of this report was to present three cases of extra-axial hemorrhages in neonates, all exhibiting refractory seizures that resolved after neurosurgical intervention. In addition, a review of literature is provided.MethodsData collected included clinical history, laboratory findings, neuroimaging studies, type of neurosurgical intervention, and patient outcome. All infants presented with extra-axial hemorrhages along with clinical and radiological signs of increased intracranial pressure within the first 6 days of life. These manifestations included a decreased level of consciousness, hypertension, bradycardia, and cerebral midline shift on imaging. Refractory seizures were present in all cases. Urgent magnetic resonance imaging was performed followed by neurosurgical intervention (two needle aspirations, one cranial trepanation), leading to amelioration of clinical symptoms and complete resolution of seizures. Follow-up outcomes included normal psychomotor development in one infant, mild cerebral paresis in another, and delayed motor development in the third. None of the infants developed epilepsy.ConclusionThis study underscores the critical importance of monitoring seizure activity, conducting urgent and appropriate imaging, and implementing targeted neurosurgical intervention, preferably through minimally invasive methods such as percutaneous needle aspiration. Clinicians should be aware of this clinical picture and respond promptly to mitigate neurological damage.

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Management of refractory neonatal seizures

Cited by 3 publications

References 110 publications

Efficacy of Levetriacetam and Phenytoin as Combination Therapy in Infants Presented with Status Epilepticus

Efficacy of Levetriacetam and Phenytoin as Combination Therapy in Infants Presented with Status Epilepticus

Refractory Seizures of Infancy with SCN2A: A Case Review

Case Report: resolution of refractory seizures after neurosurgical intervention in newborns with cerebral extra-axial hemorrhages

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