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Phenobarbitone, neonatal seizures, and video-EEG.
G B Boylan1, J M Rennie, R M Pressler
1Neonatal Intensive Care Unit, King's College Hospital, Denmark Hill, London SE5 9RS, UK. geraldine.boylan@kcl.ac.uk
Archives of Disease in Childhood. Fetal and Neonatal Edition
|April 30, 2002
Summary
Phenobarbitone is often ineffective for neonatal seizures, especially with abnormal EEG backgrounds. This study found poor outcomes in most infants treated with phenobarbitone, highlighting the need for alternative treatments.
Area of Science:
- Neonatal Neurology
- Clinical Pharmacology
- Pediatric Epilepsy
Background:
- Neonatal seizures are a critical concern requiring effective treatment.
- Phenobarbitone is a commonly used first-line anticonvulsant in neonates.
- Evaluating phenobarbitone's efficacy in this population is crucial for optimizing care.
Purpose of the Study:
- To assess the effectiveness of phenobarbitone as an initial treatment for neonatal seizures.
- To correlate EEG findings with treatment response and long-term neurodevelopmental outcomes.
Main Methods:
- An observational study utilizing video-EEG telemetry in 14 neonates receiving phenobarbitone for suspected seizures.
- EEG monitoring was conducted before and up to 24 hours after phenobarbitone administration.
- Neurodevelopmental assessment using the Griffiths scale was performed at one year for surviving infants.
Main Results:
- Only 4 out of 14 neonates responded well to phenobarbitone, particularly those with normal or moderately abnormal EEG backgrounds.
- In 10 neonates, electrographic seizures increased post-treatment, though electroclinical seizures decreased.
- Overall outcomes were poor, with only one infant achieving a normal neurodevelopmental score after receiving second-line treatment.
Conclusions:
- Phenobarbitone is frequently ineffective as a first-line anticonvulsant in neonates with significantly abnormal EEG background activity.
- The study suggests that phenobarbitone's utility may be limited in specific neonatal seizure populations.
- Further research into alternative or adjunctive therapies for neonatal seizures with abnormal EEG patterns is warranted.