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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
Insights
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.
Aims:
To evaluate the effectiveness of phenobarbitone as an anticonvulsant in neonates.
Methods:
An observational study using video-EEG telemetry. Video-EEG was obtained before treatment was started, for an hour after treatment was given, two hours after treatment was given, and again between 12 and 24 hours after treatment was given. Patients were recruited from all babies who required phenobarbitone (20-40 mg/kg intravenously over 20 minutes) for suspected clinical seizures and had EEG monitoring one hour before and up to 24 hours after the initial dose. An EEG seizure discharge was defined as a sudden repetitive stereotyped discharge lasting for at least 10 seconds. Neonatal status epilepticus was defined as continuous seizure activity for at least 30 minutes. Seizures were categorised as EEG seizure discharges only (electrographic), or as EEG seizure discharges with accompanying clinical manifestations (electroclinical). Surviving babies were assessed at one year using the Griffiths neurodevelopmental score.
Results:
Fourteen babies were studied. Four responded to phenobarbitone; these had normal or moderately abnormal EEG background abnormalities and outcome was good. In the other 10 babies electrographic seizures increased after treatment, whereas electroclinical seizures reduced. Three babies were treated with second line anticonvulsants, of whom two responded. One of these had a normal neurodevelopmental score at one year, but the outcome for the remainder of the whole group was poor.
Conclusion:
Phenobarbitone is often ineffective as a first line anticonvulsant in neonates with seizures in whom the background EEG is significantly abnormal.