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Clinical Management of Seizures in Newborns

Diagnosis and Treatment

  • Therapy in Practice
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Abstract

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. On the other hand, not all abnormal movements identified by clinicians as clinical seizures are accompanied by electroencephalographic seizure discharges in the EEG. Precise incidence is difficult to delineate and depends on study population and criteria used for diagnosis of seizures. 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. In addition, when (sub)clinical seizures are treated, there is no consensus about the most appropriate treatment for neonatal seizures and how to assess the efficacy of treatment.

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. Several (small) studies indicate that lidocaine is an effective drug for refractory seizures as second- or third-line treatment. Although data are scarce, some AEDs with a wide acceptance in adult and pediatric neurology practice are being used to treat neonatal seizures (i.e. second-generation AEDs). These drugs are chemically different from all first-generation AEDs and they have an effect on other pathways so they provide new pharmacological targets for controlling seizures in newborns. Levetiracetam, topiramate, felbamate, bumetanide, lamotrigine and vigabatrin are examples of these second-generation AEDs.

There is an urgent need for prospective, randomized, controlled trials to assess the efficacy and safety of these second-generation AEDs in neonates.

The aim of this review is to provide an overview of the current knowledge of diagnosis, the effect on brain injury, and the treatment of neonatal seizures.

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Acknowledgements

Linda van Rooij and Marcel van den Broek contributed equally to this article. No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Neonatology, KE 04.123.1, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands

    Linda G. M. van Rooij & Linda S. de Vries

  2. Department of Clinical Pharmacy, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands

    Marcel P. H. van den Broek & Carin M. A. Rademaker

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  1. Linda G. M. van Rooij
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  4. Linda S. de Vries
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Correspondence to Linda G. M. van Rooij.

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van Rooij, L.G.M., van den Broek, M.P.H., Rademaker, C.M.A. et al. Clinical Management of Seizures in Newborns. Pediatr Drugs 15, 9–18 (2013). https://doi.org/10.1007/s40272-012-0005-1

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  • DOI: https://doi.org/10.1007/s40272-012-0005-1

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