Neonatal Seizure Management: Is the Timing of Treatment Critical?

Abstract

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Translational neonatal seizure research—A reality check

“…21 Recent evidence suggests that phenobarbital may work better than previously thought if administered promptly after seizure onset. 7,22 This was especially evident in the multicenter, randomized, blinded, controlled NEOLEV2 trial, which used remote EEG monitoring to help identify and treat seizures promptly. In this study, the efficacy and safety of levetiracetam was compared with phenobarbital as a first-line treatment of seizures in term and near-term infants.…”

“…This can take up to 1-2 hours in a busy clinical setting. 7,22 All of this may be happening in the middle of the night when staff resources are at a minimum. It is perhaps not surprising that sometimes it can take many hours from seizure onset to seizure treatment.…”

“…Systematic reviews have indicated that ~50% of neonatal seizures respond to phenobarbital 21 . Recent evidence suggests that phenobarbital may work better than previously thought if administered promptly after seizure onset 7,22 …”

“…[3][4][5] Evidence is also emerging that earlier treatment is associated with better seizure control and reduced overall seizure burden. [6][7][8] However, earlier treatment is possible only if continuous EEG monitoring is available to identify the exact onset of seizures. 6,[9][10][11] Unfortunately, multicenter studies have clearly shown that there can be long gaps between the onset of seizures and the administration of first treatment, and the reasons for this are multifactorial.…”

“…Evidence is also emerging that earlier treatment is associated with better seizure control and reduced overall seizure burden 6–8 . However, earlier treatment is possible only if continuous EEG monitoring is available to identify the exact onset of seizures 6,9–11 .…”