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content:neonatal_seizures [2020/02/23 14:17] – [Differential diagnosis] icna | content:neonatal_seizures [2020/02/23 15:39] – [Neonatal seizures] icna | ||
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* Neonatal epileptic seizures occur from birth to the end of the neonatal period. | * Neonatal epileptic seizures occur from birth to the end of the neonatal period. | ||
* The neonatal period is defined as the first 28 days of life of a full-term infant. | * The neonatal period is defined as the first 28 days of life of a full-term infant. | ||
- | * Most neonatal seizures are acute (pro-voked, occasional, reactive) | + | * Most neonatal seizures are acute symptomatic seizures caused by an acute illness such as hypoxic–ischaemic encephalopathy, |
* seizures are the most common and important sign of acute neonatal encephalopathy | * seizures are the most common and important sign of acute neonatal encephalopathy | ||
* neonatal seizures are a major risk for death or subsequent neurological disability and, by themselves, may contribute to an adverse neuro-developmental outcome. | * neonatal seizures are a major risk for death or subsequent neurological disability and, by themselves, may contribute to an adverse neuro-developmental outcome. | ||
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* extremely limited evidence on the effect of phenobarbital on long-term neonatal neurodevelopment | * extremely limited evidence on the effect of phenobarbital on long-term neonatal neurodevelopment | ||
* U.S. Food and Drug Administration (FDA) has never approved phenobarbital for use in any patient population[(: | * U.S. Food and Drug Administration (FDA) has never approved phenobarbital for use in any patient population[(: | ||
+ | * animal studies have raised concerns that neonatal phenobarbital exposure induces neuronal apoptosis, disruption of synaptic development in the striatum, and other behavioral deficits[(: | ||
* **Levetiracetam** | * **Levetiracetam** | ||
* effective as second-line treatments for neonatal seizures that are unresponsive to phenobarbital | * effective as second-line treatments for neonatal seizures that are unresponsive to phenobarbital | ||
* FDA-approved for children as young as one-month of age[(: | * FDA-approved for children as young as one-month of age[(: | ||
* efficacy and safety profile has not been adequately studied in term or preterm neonates within the first month of life | * efficacy and safety profile has not been adequately studied in term or preterm neonates within the first month of life | ||
- | * dosing of 40–50mg/ | + | |
+ | | ||
* a recent open labelled RCT (Level III neonatal unit; 100 neonates) used Levetiracetam (20 mg/kg) or Phenobarbitone (20 mg/kg) intravenously and concluded that Levetiracetam achieves better control than Phenobarbitone for neonatal clinical seizures when used as first-line antiepileptic drug, and is not associated with adverse drug reactions[(: | * a recent open labelled RCT (Level III neonatal unit; 100 neonates) used Levetiracetam (20 mg/kg) or Phenobarbitone (20 mg/kg) intravenously and concluded that Levetiracetam achieves better control than Phenobarbitone for neonatal clinical seizures when used as first-line antiepileptic drug, and is not associated with adverse drug reactions[(: | ||
* phenytoin/ | * phenytoin/ | ||
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* consider pyridoxine challenge when other antiepileptics provide no response | * consider pyridoxine challenge when other antiepileptics provide no response | ||
* minimal data for many antiepileptics including topiramate, which is being increasingly used in neonates | * minimal data for many antiepileptics including topiramate, which is being increasingly used in neonates | ||
- | * steroids and / or vigabatrin are considered in epileptic spasms | + | * steroids and / or [[vigabatrin]] are considered in epileptic spasms |
- | * tonic seizures related to benign familial neonatal | + | * Low-dose carbamazepine (CBZ) should be considered as first-line treatment for benign familial neonatal |
* there is equipoise on levetiracetam vs phenobarbitone as first line treatment[(: | * there is equipoise on levetiracetam vs phenobarbitone as first line treatment[(: | ||
+ | * The 2011 World Health Organization (WHO) guidelines for neonatal seizures[(: | ||