Challenges In Neonatal Seizure Management Around The World

From Guidelines to Practice: Management Strategies for Treatment-Resistant Neonatal Seizures
Cecil D Hahn

Dr. Hahn will lead an interactive case-based discussion of a neonate with meningitis who presents with treatment-resistant neonatal seizures on the 6th day of life. This baby was initially cared for in a Level 2 nursery where aEEG monitoring was initiated following concern for encephalopathy and suspicious movements.  Suspected seizures were confirmed by aEEG, first-line anti-seizure therapy was administered and the baby was transferred to a Level 3 NICU. Upon arrival, conventional EEG monitoring was commenced which demonstrated ongoing clinical and subclinical seizures of multifocal onset requiring sequential escalation of anti-seizure therapy.  Results of aEEG and conventional video-EEG recordings, neuroimaging and laboratory results will be used to guide decision-making at each step. 

The case is designed to illustrate the application of the new ILAE Guidelines for the Treatment of Neonatal Seizures, for example how to consider the degree of diagnostic certainty when escalating anti-seizure therapy, and how to target seizure burden.  The case will also illustrate how the combined use of aEEG and conventional EEG can improve efficiency of resource utilization and timely seizure recognition and treatment by bedside caregivers especially after-hours. Participants will be asked to reflect and discuss how the ILAE Guidelines would be implemented differently at their centres based on their locally-available resources.

When seizure semiology points to etiology
Ronit Pressler

Dr Pressler will lead an interactive case-based discussion of a neonate with KCNK2 encephalopathy. Seizure onset of seizures on the 3rd day of life This baby was initially managed in a local hospital and had ongoing seizures on day 10 despite 2 different antiseizure medications. Results of neuroimaging, EEG monitoring with video examples, and metabolic screening will be presented to guide decision-making at each step. Using this case, Dr Pressler will present the value of the recent ILAE classification for neonatal seizures which provides neonatologists, pediatricians, and neurologists a common language to identify, diagnose, and treat neonatal seizures. This classification uses the same framework and terminology as the 2017 ILAE seizure classification but is tailored toward neonates. Seizures electrographic-only or with clinical manifestations which include motor events (automatisms, clonic, epileptic spasms, myoclonic, tonic), non-motor events (autonomic, behavior arrest), or mixed (sequential seizures, unclassified). It has been shown that some seizure types are indicative of specific diagnosis and consequently management. The value of this classification in different healthcare settings will also be discussed.