Neonatal seizures: dilemmas in workup and management.
There is a pressing need for consistent, evidence-based guidelines in the management of neonatal seizures by pediatric neurologists and neonatologists. Israeli pediatric neurologists and neonatologists completed a 20-item, self-administered questionnaire on choices of antiepileptic drugs, treatment of intractable neonatal seizures (unremitting seizures after 3 medications), treatment duration, and recommended workup. The responding 36/55 (65%) neurologists and 66/112 (59%) neonatologists made similar antiepileptic drug choices (phenobarbital as first line, phenytoin as second line, and benzodiazepines as third line). Antiepileptic treatment duration was similar for both groups, but varied considerably within them (range, 1-52 weeks). Neurologists tended to recommend longer treatment for seizures secondary to asphyxia or hemorrhage. Neurologists and neonatologists recommended different antiepileptic drugs for intractable neonatal seizures: valproic acid and topiramate by neurologists, vs lidocaine and benzodiazepines by neonatologists (P = 0.0023). Fewer neurologists recommended continuous electroencephalography monitoring after asphyxia than neonatologists (40% vs 70.5%, P = 0.013). These responses reflect both similarities and inconsistencies of the two groups in diagnosing and treating neonatal seizures. Our findings call for controlled clinical trials to establish protocols for (1) diagnosing neonatal seizures, (2) studying the efficacy and safety of new-generation antiepileptic drugs, and (3) determining optimal duration of drug administration.
Bassan
Haim
H
Pediatric Neurology Unit, Neonatal Neurology Service, Dana Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. bassan@post.tau.ac.il
Bental
Yoram
Y
Shany
Eilon
E
Berger
Itai
I
Froom
Paul
P
Levi
Loren
L
Shiff
Yakov
Y
D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000002:abnormalities; D019411:Clinical Laboratory Techniques; D003625:Data Collection; D004363:Drug Utilization; D004569:Electroencephalography; D006801:Humans; D007231:Infant, Newborn; D007557:Israel; D008590:Meningoencephalitis / Q000150:complications; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D011795:Surveys and Questionnaires
D000927:Anticonvulsants