Recent advances in neonatal seizures.

Area of Science:

• Neonatal neurology
• Pediatric epilepsy
• Neurocritical care

Background:

• Neonatal seizures are critical indicators of underlying brain injury in newborns.
• The immature neonatal brain has a lower seizure threshold and unique seizure presentations.
• Etiologies vary, with hypoxic ischemic encephalopathy being the most common cause.

Purpose of the Study:

• To provide a comprehensive overview of neonatal seizures.
• To discuss classification, diagnosis, and management strategies.
• To highlight prognostic factors and the importance of long-term follow-up.

Main Methods:

• Classification based on presentation (clinical, electroclinical, electroencephalographic) and pathophysiology (epileptic, nonepileptic).
• Diagnosis primarily relies on electroencephalography (EEG), with amplitude-integrated EEG (aEEG) for continuous monitoring.
• Management involves stabilization, addressing correctable causes, and antiepileptic drug (AED) therapy.

Main Results:

• Hypoxic ischemic encephalopathy is the leading cause, followed by hemorrhage, metabolic issues, infections, and strokes.
• Phenobarbital is the first-line AED, though pharmacokinetic data for newer agents are limited.
• Prognosis is linked to etiology, seizure characteristics, neurological status, and EEG findings.

Conclusions:

• Neonatal seizures require prompt diagnosis and management, with EEG as the gold standard.
• Effective treatment involves addressing underlying causes and appropriate AED selection.
• Long-term neurodevelopmental follow-up is crucial for affected infants.