Neonatal seizures: diagnosis and management

Area of Science:

• Neonatal Neurology
• Pediatric Epilepsy
• Clinical Neurophysiology

Background:

• Neonatal seizures present diagnostic challenges due to diverse paroxysmal motor phenomena, requiring precise differentiation for effective management.
• Etiologies are multifactorial, region-specific, and evolving, with hypoxia-ischemia and infections remaining prevalent globally.
• Increasing recognition of cerebrovascular events and the importance of identifying treatable conditions like inborn errors of metabolism are critical.

Purpose of the Study:

• To review current information on neonatal seizures.
• To provide evidence-based suggestions for the management of neonatal seizures.
• To highlight key considerations in diagnosis and treatment strategies.

Main Methods:

• Review of existing literature and clinical guidelines on neonatal seizures.
• Analysis of etiological factors and their impact on prognosis.
• Evaluation of current treatment protocols and drug choices.

Main Results:

• Phenobarbital is the established first-line anti-epileptic drug globally for neonatal seizures.
• Pharmacogenetics and organ dysfunction necessitate dose adjustments for all anti-epileptic drugs.
• Early consideration of vitamin-responsive seizures (pyridoxine, folinic acid, biotin) is recommended for intractable cases.

Conclusions:

• Accurate diagnosis, often aided by video-EEG monitoring, is crucial for appropriate neonatal seizure management.
• Etiology significantly influences patient outcomes, emphasizing early identification and treatment of underlying causes.
• Management strategies should account for drug pharmacokinetics, potential toxicities, and the specific nature (acute symptomatic vs. chronic) of seizures.