Treatment of Neonatal Seizures: Comparison of Treatment Pathways From 11 Neonatal Intensive Care Units

Keene, Jennifer C.; Morgan, Lindsey A.; Abend, Nicholas S.; Bates, Sara V.; Huang, Sarah L. Bauer; Chang, Taeun; Chu, Catherine J.; Glass, Hannah C.; Massey, Shavonne L.; Ostrander, Betsy; Pardo, Andrea C.; Press, Craig A.; Soul, Janet S.; Shellhaas, Renée A.; Thomas, Cameron; Natarajan, Niranjana

doi:10.1016/j.pediatrneurol.2021.10.004

Cited by 22 publications

(36 citation statements)

References 46 publications

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“…A new sodium channel blocker very promising for neonatal seizures is represented by lacosamide, a manageable drug with a good safety profile for which both intravenous and oral syrup formulations have been produced. Lacosamide has been very recently used as an alternative third-option anti-seizure medication for refractory neonatal seizures in some centers ( 21 ). Lacosamide has also been demonstrated effective in two neonates with SCN2A -related intractable seizures ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Effect of Targeted Therapy With Carbamazepine in KCNQ2 Neonatal Epilepsy

et al. 2022

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We present a family case of neonatal-onset KCNQ2-related epilepsy due to a novel intronic mutation. Three members of an Italian family (father and offspring) presented with neonatal-onset asymmetric tonic and clonic seizures with peculiar video-electroencephalography and aEEG features referring to sequential seizures. The father and the first son underwent standard of care treatments in line with current neonatal intensive care unit protocols, with a prolonged hospitalization before reaching full seizure control with carbamazepine. After the experience acquired with her family and the latest advances in the literature, the younger daughter was directly treated with carbamazepine, obtaining rapid seizure control and short hospitalization. They all had normal development. Carbamazepine is rarely administered as a first-line option in neonatal seizures. Recent evidence suggests that neonatal intensive care unit protocols should implement a trial with sodium channel blockers such as carbamazepine as first-option anti-seizure medication and a fast access to genetic testing in neonates with sequential seizures without structural brain injury or acute causes. Moreover, we report and discuss the laboratory studies performed on a novel causative intronic mutation in KCNQ2 (c.1525+5 G>A in IVS13), since pathogenicity may be difficult to prove for intronic variants.

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Section: Discussionmentioning

confidence: 99%

Case Report: Effect of Targeted Therapy With Carbamazepine in KCNQ2 Neonatal Epilepsy

et al. 2022

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“…Phenytoin or levetiracetam as secondline treatment has not yielded superior results. 42) Levetiracetam is attractive for its neuroprotective effect, 43) although a recent study suggested poor seizure termination efficacy compared to phenobarbital. 44) Moreover, many centers use midazolam infusion for persistent events.…”

Section: Treatmentmentioning

confidence: 99%

“…44) Moreover, many centers use midazolam infusion for persistent events. 42) Lidocaine is also an alternative in refractory cases if phenytoin has not been previously utilized. 45) Alternative drugs, such as topiramate, have more limited use because of the unavail ability of an intravenous formulation despite its neuroprotective effect.…”

Section: Treatmentmentioning

confidence: 99%

“…First-line therapy that acts through the gammaaminobutyric acid (GABA) receptor, that is, phenobarbital and benzodiazepines. Phenytoin or levetiracetam as second-line treatment has not yielded superior results [ 42 ]. Levetiracetam is attractive for its neuroprotective effect [ 43 ], although a recent study suggested poor seizure termination efficacy compared to phenobarbital [ 44 ].…”

Section: Treatmentmentioning

confidence: 99%

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Neonatal seizures: stepping outside the comfort zone

Hashish

Bassiouny

2022

Clin Exp Pediatr

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Seizures are the most common neurological disorders in newborns. Managing neonatal seizures is challenging, especially for neurologists who are not neonatal specialists. Acute brain injury during ischemic insult is a key component of seizure occurrence, while genetic and metabolic disorders play less prevalent but more severe roles. The diagnosis of neonatal seizure is ambiguous, as the subjective differentiation between seizure and nonepileptic events is difficult; therefore, electrographic recording is the gold standard for diagnosis. The detection of electrographic seizures by neonatologists is currently facilitated by amplitude-integrated electroencephalography availability in many neonatal intensive care units. Although it is less sensitive than conventional electroencephalography, it is better to record all risky neonates to filter the abnormal events as early as possible to enable the initiation of dedicated therapy at proper dose and time and facilitate the initial response to antiepileptic drugs. This, in turn, helps maintain the balance between unnecessary drug use and their neurotoxic effects. Moreover, the early treatment of electrographic seizures plays a vital role in the suppression of subsequent abnormal brain electricity (status epilepticus) and shortening the hospital stay. An explicit understanding of seizure etiology and pathophysiology should direct attention to the proper prescription of short- and long-term antiepileptic medications to solve the challenging issue of whether neonatal seizures progress to postneonatal epilepsy and long-term cognitive deficits. This review addresses recent updates in different aspects of neonatal seizures, particularly electrographic discharge, including their definition, etiology, classification, diagnosis, management, and neurodevelopmental outcomes.

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“…In a 2004 Cochrane review [2], the authors concluded that "there is little evidence from randomized controlled trials to support the use of any of the anticonvulsants currently used in the neonatal period." Although neonatal seizure management pathways differ between institutions and settings, the most commonly used ASMs are phenobarbital (PB), phenytoin (PHT), and levetiracetam (LEV), with alternatives including lacosamide (LCM), and escalation to continuous midazolam (MDZ) infusion [11]. However, overall response rates to ASM are low, whereas the selflimited nature of acute provoked seizures and the potential neurotoxicity of ASM to the immature brain dictate caution.…”

Section: Medication Selectionmentioning

confidence: 99%

Neonatal seizures—diagnostic options and treatment recommendations

Ramantani

Pisani

2022

Z. Epileptol.

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Seizures in neonates should prompt rapid evaluation to verify the diagnosis, determine etiology, and initiate appropriate treatment. Neonatal seizure diagnosis requires EEG confirmation and clinical observation alone is insufficient. Although most neonatal seizures are related to acute brain injury, some neonates present early-onset structural or metabolic/genetic epilepsy. Video-EEG monitoring, the gold standard for neonatal seizure detection and quantification, is resource-intensive and often unavailable, with amplitude-integrated EEG offering a reasonable alternative in guiding treatment. Whereas new-generation antiseizure medication (ASM), such as levetiracetam, appear promising, particularly in terms of tolerability, older-generation ASM, such as phenobarbital and phenytoin, are yet to be replaced. Acute treatment should aim at stopping both electroclinical and electrographic-only seizures. In neonates with acute provoked seizures, ASM should be discontinued without tapering after 72 h of seizure freedom and before hospital discharge.

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Treatment of Neonatal Seizures: Comparison of Treatment Pathways From 11 Neonatal Intensive Care Units

Cited by 22 publications

References 46 publications

Case Report: Effect of Targeted Therapy With Carbamazepine in KCNQ2 Neonatal Epilepsy

Case Report: Effect of Targeted Therapy With Carbamazepine in KCNQ2 Neonatal Epilepsy

Neonatal seizures: stepping outside the comfort zone

Neonatal seizures—diagnostic options and treatment recommendations

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