Anticonvulsants for neonates with seizures

Area of Science:

• Neonatal neurology
• Clinical pharmacology
• Evidence-based medicine

Background:

• Neonatal seizures are common, with varied treatment practices due to limited evidence on anticonvulsant efficacy and safety.
• The routine use of anticonvulsants in neonates requires rigorous evaluation.

Purpose of the Study:

• To assess and compare the benefits and harms of different anticonvulsants used to treat neonatal seizures.

Main Methods:

• Systematic search of electronic databases (MEDLINE, EMBASE, CENTRAL) and hand searches for relevant randomized controlled trials (RCTs).
• Inclusion criteria focused on RCTs comparing anticonvulsants with placebo, no drug, or alternative anticonvulsants, reporting outcomes like mortality, neurodevelopmental disability, and adverse events.
• Methodological quality was assessed, and data were extracted and analyzed by two reviewers.

Main Results:

• Only two full RCTs were identified. Phenobarbital and phenytoin showed similar efficacy (controlling seizures in <50% of infants) but did not report mortality or neurodevelopmental outcomes.
• A second-line treatment study found a trend for lidocaine to be more effective than midazolam in reducing seizure burden, but long-term outcomes were poor in both groups.

Conclusions:

• Currently, there is insufficient high-quality RCT evidence to support the use of specific anticonvulsants for neonatal seizures.
• While seizures are concerning, evidence for their harm is limited. Future large, high-quality RCTs are essential to develop safe and effective neonatal seizure treatment strategies.
• Future research should focus on detecting clinically significant reductions in mortality and neurodevelopmental disability.