Status Epilepticus in the Neonate: Updates in Treatment Strategies

Evaluation of the efficacy and safety of levetiracetam treatment for neonatal seizures in extremely preterm infants

“…Seizures are one of the most common and serious neurological emergencies in the neonatal period [1,2]. Neonatal seizures occur in 1-3 per 1000 term newborns and it may increase up to 10-130 per 1000 in preterm neonates [2][3][4].…”

“…Neonatal seizures occur in 1-3 per 1000 term newborns and it may increase up to 10-130 per 1000 in preterm neonates [2][3][4]. The neonatal period is the most important period of life for developing seizures, because neonatal seizures, especially if prolonged, were reportedly associated with poor neurodevelopmental outcomes, as it may negatively affect the immature brain of premature infants [1,5,6]. Therefore, treatment and management of neonatal seizures are particularly important to reduce neurological disabilities of children [1,5].…”

“…Neonatal seizures usually manifest with stereotypical muscular activity or autonomic changes, and are a result of abnormal electrical discharges in the central nervous system of neonates, occurring within the first 28 days after birth in fullterm infants or until 44 weeks of gestational age in preterm infants [1,4,7]. The etiologies of neonatal seizures are reported in a broad spectrum, such as hypoxic-ischemic encephalopathy (HIE), infections, metabolic and electrolyte disturbances, brain injuries, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and brain malformations [1,8].…”

“…Neonatal seizures usually manifest with stereotypical muscular activity or autonomic changes, and are a result of abnormal electrical discharges in the central nervous system of neonates, occurring within the first 28 days after birth in fullterm infants or until 44 weeks of gestational age in preterm infants [1,4,7]. The etiologies of neonatal seizures are reported in a broad spectrum, such as hypoxic-ischemic encephalopathy (HIE), infections, metabolic and electrolyte disturbances, brain injuries, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and brain malformations [1,8]. Extremely preterm infants who are born ≤28 weeks gestational age may be more vulnerable to neonatal seizures than other preterm and term neonates due to the immaturity of their nervous system, and they can have a lot of comorbidities including various disorders of the brain, which may lead to the decrease of seizure threshold [7,9].…”

“…Despite a highly broad spectrum of etiologies and their importance on neurodevelopmental outcomes, we only have a few treatment options to manage neonatal seizures. In the neonatal period, phenobarbital and phenytoin are well known and the most often used antiepileptic drugs, because they are the only two drugs which have been approved by the FDA for the treatment of neonatal seizures [1][2][3]. However clinical studies showed that both have some side effects during the acute seizure treatment period or long-term use [2,5,10].…”