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--- content:neonatal_seizures [2020/02/23 14:37] – [Management] icna
+++ content:neonatal_seizures [2020/02/23 14:46] – [Management] icna
@@ Line 182: / Line 182: @@
     * 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[(:cite:17342837>{{pubmed>17342837}})]
+    * animal studies have raised concerns that neonatal phenobarbital exposure induces neuronal apoptosis, disruption of synaptic development in the striatum, and other behavioral deficits[(:cite:29315524>{{pubmed>29315524}})]
   * **Levetiracetam**
     * effective as second-line treatments for neonatal seizures that are unresponsive to phenobarbital
     * FDA-approved for children as young as one-month of age[(:cite:fda>U.S. Dept. of Health and Human Services. [cited 2012 Oct 5];Food and Drug Administration Center for Drug Evaluation and Research. Application Number NDA 21505/S-026 [Internet] Available from: http://www.accessdata.fda.gov)]
     *  efficacy and safety profile has not been adequately studied in term or preterm neonates within the first month of life
-    * dosing of 40–50mg/kg bolus has been suggested [(:cite:21397167>{{pubmed>21397167}})]
+    * current literature suggests loading doses of 10 to 20 mg/kg are appropriate and effective in neonates, with a maintenance dose range of 10 to 80 mg/kg/day divided twice daily[(:cite:25964725>{{pubmed>25964725}})]
+    * dosing of 40–50mg/kg bolus has also been suggested [(:cite:21397167>{{pubmed>21397167}})]
     * 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[(:cite:31477643>{{pubmed>31477643}})]
   * phenytoin/fosphenytoin
@@ Line 204: / Line 206: @@
   * consider pyridoxine challenge when other antiepileptics provide no response
   * 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 seizures are treated with carbamazepine
+  * Low-dose carbamazepine (CBZ) should be considered as first-line treatment for benign familial neonatal epilepsy (BNFE), even in cases of status epilepticus[(:cite:27888506>{{pubmed>27888506}})]
   * there is equipoise on levetiracetam vs phenobarbitone as first line treatment[(:cite:31992265>{{pubmed>31992265}})]
   * The 2011 World Health Organization (WHO) guidelines for neonatal seizures[(:cite:who2011)] and the 2010 Queensland Maternity and Neonatal Clinical Guidelines for neonatal seizures[(:cite:queensland2013>Queensland Department of Health. Queensland Clinical guidelines. Translating evidence into best clinical practice: maternity clinical guidelines. http://www.health.qld.gov.au/qcg/html/publications.asp#Neonatal. Accessed March 10, 2013)] recommend phenobarbital as the first-line agent for treatment of neonatal seizures, followed by phenytoin, and then benzodiazepines