Currently, the World Health Organization (WHO) recommends the use of phenobarbital and phenytoin as first-line treatment [ 15] options for neonatal seizures, despite the low-quality evidence available to support their efficacy and the number of studies highlighting their potential side effects, which include increasing neuronal apoptosis and, consequently, contributing to long-term neurological damage and adverse neurocognitive outcomes [ 16, 17 ].
Full Answer
What are the treatment options for seizures in newborns?
10. 6 Maintenance anti-epileptic therapy Principles of AED used in older children and adults are applicable to neonates also. Monotherapy is the most appropriate strategy to control seizures. Attempts should be made to stop all anti-epileptic drugs and wean the baby to only phenobarbitone at 3-5 mg/kg/day.
What is the standard method of diagnosis of neonatal seizures?
the standard method of diagnosis is the clinical recognition of neonatal seizures. † The risk of performing an EEG on a neonate is minimal, predominantly related to tran- sient discomfort and scalp irritation.
Do conventional anticonvulsants improve outcome in neonates with electrographic seizures?
These findings suggest that in full-term or near-term neonates with heterogeneous etiologies for seizures, treatment of electrographic seizures with conventional anticonvulsants was not associated with outcome. Abstract Importance Seizures in the neonatal period are associated with increased mortality and morbidity.
Should pediatric seizures be treated in the emergency department?
Treating pediatric seizures in the emergency department poses myriad challenges for the ED physician. Parents are frightened and frantic, and those involved in the care of the child may also be anxious.
What is the treatment of neonatal seizures?
Current therapeutic options to treat neonatal seizures (i.e. primarily first-generation antiepileptic drugs [AEDs]) are relatively ineffective. In practice, phenobarbital still remains the drug of first choice for EEG confirmed or suspected seizures. Benzodiazepines are also used in (phenobarbital) refractory cases.
What is the first drug of choice to treat seizures in a neonate?
Phenobarbital is the most commonly used AED for treating neonatal seizures. The dosage aims at reaching a level in the baby's blood (a free plasma concentration) of at least 25 micrograms per milliliter (mcg/mL).
What is the most common clinical presentation of a neonatal seizure?
Neonatal seizures are usually focal and may be difficult to recognize; common manifestations include migratory clonic jerks of extremities, chewing movements, persistent eye deviations or nystagmoid movements, and episodic changes in muscle tone.
What is the first line treatment for seizure?
For generalised tonic-clonic seizures, sodium valproate is recommended as first-line treatment. If this is unsuitable, lamotrigine is recommended. Carbamazepine and oxcarbazepine can be considered as alternatives.
Why is phenobarbital used for infants?
Phenobarbital is used to treat infants (ages 0-1 year) with any type of seizure disorder, and other children with generalized, partial or febrile seizures. It is also used for treatment of status epilepticus (seizures lasting greater than 15 minutes).
Can newborn seizures be cured?
If there is a cause that can be treated, such as a low blood sugar level, then that will usually stop the seizures also. Sometimes your baby needs medicine to help control the seizures. These are usually only given for a short time. These medicines do not 'cure' the seizures, they treat the signs your baby is showing.
What are signs of seizures in newborns?
Symptoms of Subtle SeizuresRandom or roving eye movements, eyelid blinking or fluttering, eyes rolling up, eye opening, staring.Sucking, smacking, chewing and protruding tongue.Unusual bicycling or pedalling movements of the legs.Thrashing or struggling movements.Long pauses in breathing (apnea)
Which type of seizure is least common in newborns?
Myclonic seizures may be focal, multifocal or generalized and are the least common of the four varieties during the neonatal period.
Why would a newborn baby have seizures?
Neonatal seizures can have many causes, including lack of oxygen before or during birth, an infection acquired before or after birth, bleeding in the brain, blood sugar or electrolyte imbalances or drug withdrawal.
What is the best treatment for seizures?
Anti-epileptic drugs (AEDs) AEDs are the most commonly used treatment for epilepsy. They help control seizures in around 7 out of 10 of people. AEDs work by changing the levels of chemicals in your brain.
What are the treatment for seizures?
Treatment for seizures often involves the use of anti-seizure medications. There are many different options for anti-seizure medication. One of the more recent medications approved by the Food and Drug Administration, cannabidiol (Epidiolex), is derived from marijuana.
What is the most effective seizure medication?
Conclusion: In this study of older adults with epilepsy, lamotrigine was the most effective AED as measured by 12-month retention and seizure freedom, with levetiracetam a close second. Oxcarbazepine was consistently less effective than most other AEDs.
What is the classification of seizures in newborns?
Clinical management of seizures in newborns : diagnosis and treatment. Neonatal seizures can be classified as tonic, clonic, myoclonic, and subtle. A clinical diagnosis is not easy as seizures are usually subtle in neonates. In the majority of newborn infants seizures are subclinical.
Is a seizure a clinical diagnosis?
A clinical diagnosis is not easy as seizures are usually subtle in neonates. In the majority of newborn infants seizures are subclinical. On the other hand, not all abnormal movements identified by clinicians as clinical seizures are accompanied by electroencephalographic seizure discharges in the EEG.
Is phenobarbital used for seizures?
In practice, phenobarbital still remains the drug of first choice for EEG confirmed or suspected seizures. Benzodiazepines are also used in (phenobarbital) refractory cases.
Is a seizure subclinical?
In the majority of newborn infants seizures are subclinical. On the other hand, not all abnormal movements identified by clinicians as clinical se …. Neonatal seizures can be classified as tonic, clonic, myoclonic, and subtle. A clinical diagnosis is not easy as seizures are usually subtle in neonates. In the majority of newborn infants seizures ...
Can seizures cause brain damage?
Controversy exists as to whether neonatal seizures themselves cause damage to the developing brain, or if the damage is primarily due to the underlying cause of the seizures. As a result of this controversy there is ongoing discussion whether all seizures (both clinical and subclinical) should be treated.
What is a seizure in children?
A seizure is abnormal electrical activity in the brain. At least half of newborns who have seizures will have long-term health problems, such as epilepsy or an intellectual disability. Medicines can treat seizures. But these medicines can have serious side effects and may harm children’s brain development.
When did parents complete seizure surveys?
Parents completed surveys when children were 12, 18, and 24 months old. The research team reviewed health records to collect data about the newborns’ health and hospital stays.
What are the effects of antiseizure medication on parents?
Compared with parents whose infants maintained treatment with antiseizure medications after discharge, parents of infants who discontinued treatment with medications reported a lower impact of the illness on the family but worse anxiety, depression, and resilience.
How long did researchers follow the infants?
Limitations. Researchers followed the infants until age two. Longer follow-up may be able to detect differences in outcomes in older children. Fewer infants developed epilepsy than researchers anticipated, which reduced the precision of the estimated differences in the risk of developing epilepsy.
What percent of newborns take medicine at home?
Of newborns in the study, 36 percent took medicines only in the hospital, and 64 percent took medicines in the hospital and at home. Among newborns who took medicines at home, 68 percent took phenobarbital. 13 percent took levetiracetam. 20 percent took more than one medicine.
What is a neonatal seizure?
Neonatal seizures, one of the most frequent neurological events in newborn infants, reflect a variety of pre-, peri- or postnatal disorders of the central nervous system (CNS). These may range from benign, self-limited illnesses to severe, prolonged or life-threat-. ening disorders.
When can a nurse practitioner be in contact with an infant with seizures?
sionals who may be in contact with infants experiencing seizures within the first 28 days. of life (age up to 44 weeks post-conception).
How often do seizures occur in neonatal patients?
Neonatal seizures have been estimated to occur in up to3–5out of every 1000 births, and preterm newborns are estimated to develop seizures more frequently than full- term newborns, with an overall incidence of1 0–15 per1,000 preterm newborns, compared with 3–5 per 1000 full-term newborns and a prevalence of 22.2% among preterm newborns, compared with 0.5% among full term newborns [ 1, 2 ]. Moreover, because improved critical care has increased the survival rate following neonatal seizures, long-term neurological sequelae constitute a growing challenge for neonatologists. Greater than 50% of survivors, especially among preterm newborns, experience considerable disabilities across a range of developmental domains, with cerebral palsy and intellectual disability being the most frequently reported [ 2, 3, 4 ]. Recent studies have shown a 17.6% over- all incidence in epilepsy among children with a history of neonatal seizures [ 5 ].
What is the best treatment for genetic channelopathies?
Several papers have described the efficacy of sodium-channel blockers for the treatment of genetic channelopathies. Phenytoin, lidocaine, carbamazepine, and oxcarbazepine act to block the movement of sodium ions through ion channels during the propagation of action potentials to prevent seizure activity.
When was the last update for the PubMed database?
The search period was from August 1949 to November 2020 (last update 30/11/2020). The only filters applied were publication in the English language and human studies.
Is seizures in newborns neurotoxic?
The therapeutic management of seizures in the newborns has remained unchanged for decades, despite almost 20 years evidence that commonly-used medications are not only ineffective but also potentially neurotoxic for newborns.
Is there any evidence for a pharmacologic treatment for neonatal seizures?
After more than 20 years of experience, limited evidence exists regarding the best pharmacologic treatments for neonatal seizures. Treatment, too often, remains guided by experience, because few RCTs have been performed and the data available from those that have been performed have not been significant.
How to manage seizures in a newborn?
The first step in successful management of seizures is to nurse the baby in thermoneutral environment and to ensure airway, breathing, and circulation (TABC). Oxygen should be started, IV access should be secured, and blood should be collected for glucose and other investigations. A brief relevant history should be obtained and quick clinical examination should be performed. All this should not require more than 2-5 minutes.
What tests are done for seizures in neonates?
Essential investigations: Investigations that should be considered in all neonates with seizures include blood sugar, serum sodium and calcium, cerebrospinal fluid (CSF) examination, cranial ultrasound (US), and electroencephalography (EEG). CSF examination should be done in all cases as seizure may be the first sign of meningitis. It should not be omitted even if another etiology such as hypoglycemia is present. CSF study may be withheld temporarily if severe cardio-respiratory compromise is present or even omitted in infants with severe birth asphyxia (documented abnormal cord pH/base excess and onset of seizures within 12-24 hrs of life).
What is a NS in a newborn?
Neonatal seizures (NS) are the most frequent and distinctive clinical manifestation of neurological dysfunction in the newborn infant . Infants with NS are at a high risk of neonatal death or neurological impairment/epilepsy disorders in later life. Though mortality due to NS has decreased from 40% to about 20% over the years, the prevalence of long-term neurodevelopment sequelae has largely remained unchanged at around 30%.1 Improper and inadequate management of seizures could be one of the major reasons behind this phenomenon.
What to look for in a generalized seizure?
2. Generalized seizures involve both hemispheres, so look for convulsive bilateral motor involvement, but don't be surprised if there are no convulsions present.
What is the most common convulsive event in pediatrics?
Currently, there are no consensus guidelines for the treatment of these seizures, and inter-physician management varies widely. 12 (See Table 1) Febrile seizures are the most common convulsive events in pediatrics, occurring in 2-5% of children and accounting for the most common cause of provoked seizures. 1. Pearl.
Can a first time seizure be a first seizure?
What appears as a first-time seizure may not actually be a patient's first seizure. Diagnosis of epilepsy is made after 2 unprovoked seizures or 1 unprovoked with an abnormal EEG.2. Intubation. Airway is a priority in the seizing patient.
Can a child feign seizure activity?
These are more common in the adolescent population since the younger pediatric patient cannot feign seizure activity. 3. Loss of consciousness always precedes perceived seizure activity with syncope.
Can benzodiazepines be given intramuscularly?
Benzodiazepines are best administered intravenously but can also be given intraosseously, intranasally (lorazepam and midazolam), intramuscularly ( midazolam) and rectally (diazepam) 17 if IV access is difficult to obtain in pediatric patients. If seizing continues, try one more dose of benzodiazepines.
Can you give pyridoxine to a child with seizures?
Pyridoxine and When To Use It#N#Pyridoxine-dependent seizures are a diagnosis unique to pediatric patients. Administer pyridoxine (100 mg IV) to infants with seizures unresponsive to conventional anticonvulsants (defined as unresponsive to first and second line antiseizure medications). 24
Why is it important to treat seizures in neonates?
Treatment directed at the cause of neonatal seizures is critical since it may prevent further brain injury. This is particularly true for seizures associated with some metabolic disturbances (eg, hypoglycemia, hypocalcemia, and hypomagnesemia) and with central nervous system (CNS) or systemic infections.
What causes seizures in neonates?
Neonatal encephalopathy — Neonatal encephalopathy (and associated hypoxic-ischemic encephalopathy) is the most common cause of neonatal seizures [ 1 ]. Even with therapeutic hypothermia for neuroprotection, about 50 percent of newborns with hypoxic ischemic encephalopathy have electrographic seizures [ 2 ].
Can seizures be a sign of a central nervous system disorder?
The occurrence of neonatal seizures may be the first, and perhaps the only, clinical sign of a central nervous system disorder in the newborn infant. Seizures may indicate the presence of a potentially treatable etiology and should prompt an immediate evaluation to determine cause and to institute etiology-specific therapy. In addition, seizures themselves may require emergent therapy, since they can adversely affect the infant's homeostasis or they may contribute to further brain injury. Some types of neonatal seizures are associated with a relatively high incidence of early death and, in survivors, a high incidence of neurologic impairment, developmental delay, and postneonatal epilepsy.