Treatment of neonatal seizures

Rooij, Linda G. M. van; Hellström‐Westas, Lena; Vries, Linda S. de

doi:10.1016/j.siny.2013.01.001

Cited by 75 publications

(55 citation statements)

References 66 publications

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“…Even the detection of electrographic seizures can be challenging as the epileptiform activity of preterm infants is brief and often below the frequency filter threshold (<2 Hz). The use of an automated seizure detection algorithm and inspection of the raw tracing are important adjuncts to improve sensitivity [36]. …”

Section: Seizures In the Preterm Infantmentioning

confidence: 99%

Advances in Management of Neonatal Seizures

Vesoulis

Mathur

2014

Indian J Pediatr

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Seizures are more common in the neonatal period than any other time in the human lifespan. A high index of suspicion for seizures should be maintained for infants who present with encephalopathy soon after birth, have had a stroke, central nervous system (CNS) infection or intracranial hemorrhage or have a genetic or metabolic condition associated with CNS malformations. Complicating the matter, most neonatal seizures lack a clinical correlate with only subtle autonomic changes and often no clinical indication at all. Over the last three decades, several tools have been developed to enhance the detection and treatment of neonatal seizures. The use of electroencephalography (EEG) and the later development of amplitude-integrated EEG (aEEG), allows for Neurologists and non-Neurologists alike, to significantly increase the sensitivity of seizure detection. When applied to the appropriate clinical setting, time to diagnosis and start of therapy is greatly reduced. Phenobarbital maintains the status of first-line therapy in worldwide use. However, newer anti-epileptic agents such as, levetiracetam, bumetanide, and topiramate are increasingly being applied to the neonatal population, offering the potential for seizure treatment with a significantly better side-effect profile. Seizures in premature infants continue to confound clinicians and researchers alike. Though the apparent seizure burden is significant and there is an association between seizures and adverse outcomes, the two are not cleanly correlated. Compounding the issue, GABA-ergic anti-epileptic drugs are not only less effective in this age group due to reversed neuronal ion gradients but may also cause harm. Selecting an appropriate treatment group remains a challenge.

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Section: Seizures In the Preterm Infantmentioning

confidence: 99%

Advances in Management of Neonatal Seizures

Vesoulis

Mathur

2014

Indian J Pediatr

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“…Phenobarbital is used as an antiepileptic drug to manage seizures in neonates and infants (Bartha et al, 2007;van Rooij et al, 2013). Neonatal seizure is a common problem affecting 1 to 4 infants for every 1000 births in North America (Lanska et al, 1995;Ronen et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Dose of Phenobarbital and Age of Treatment at Early Life are Two Key Factors for the Persistent Induction of Cytochrome P450 Enzymes in Adult Mouse Liver

et al. 2015

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Drug treatment of neonates and infants and its long-term consequences on drug responses have emerged in recent years as a major challenge for health care professionals. In the current study, we use phenobarbital as a model drug and mouse as an in vivo model to demonstrate that the dose of phenobarbital and age of treatment are two key factors for the persistent induction of gene expression and consequential increases of enzyme activities of Cyp2b, Cyp2c, and Cyp3a in adult livers. We show that phenobarbital treatment at early life of day 5 after birth with a low dose (<100 mg/kg) does not change expression and enzyme activities of Cyp2b, Cyp2c, and Cyp3a in adult mouse liver, whereas phenobarbital treatment with a high dose (>200 mg/kg) significantly increases expression and enzyme activities of these P450s in adult liver. We also demonstrate that phenobarbital treatment before day 10 after birth, but not at later ages, significantly increases mRNAs, proteins, and enzyme activities of the tested P450s. Such persistent induction of P450 gene expression and enzyme activities in adult livers by phenobarbital treatment only occurs within a sensitive age window early in life. The persistent induction in gene expression and enzyme activities is higher in female mice than in male mice for Cyp2b10 but not for Cyp2c29 and Cyp3a11. These results will stimulate studies to evaluate the long-term impacts of drug treatment with different doses at neonatal and infant ages on drug metabolism, therapeutic efficacy, and drug-induced toxicity throughout the rest of life.

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“…Other diagnostic modalities include EEG and MRI 7. The anticonvulsant of choice is phenobarbitone while the underlying cause is being determined and treated 8 9. More detailed descriptions can be read from the many expert reviews available 3…”

Section: Discussionmentioning

confidence: 99%