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2014 ; 81
(6
): 592-8
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Advances in management of neonatal seizures
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Vesoulis ZA
; Mathur AM
Indian J Pediatr
2014[Jun]; 81
(6
): 592-8
PMID24796413
show ga
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 cause harm. Selecting an appropriate
treatment group remains a challenge.