Pharmacotherapy for Neonatal Seizures: Current Knowledge and Future Perspectives

Area of Science:

• Neonatal neurology
• Neurocritical care
• Developmental neuroscience

Background:

• Neonatal seizures are the most common neurological emergencies, affecting up to 5 per 1000 term births and more frequently in premature infants.
• They indicate underlying cerebral pathology, frequently hypoxic-ischaemic encephalopathy, and can exacerbate brain injury, necessitating prompt diagnosis and treatment.
• Electroencephalography (EEG) is vital for diagnosing subtle neonatal seizures due to non-specific presentations and electro-clinical uncoupling.

Purpose of the Study:

• To review the efficacy, safety, tolerability, and pharmacokinetics of seven anticonvulsant drugs for electrographically confirmed neonatal seizures.
• To identify knowledge gaps in optimal treatment regimens for neonatal seizures.
• To emphasize the need for randomized controlled trials to establish effective treatment protocols.

Main Methods:

• Focused review of studies reporting electrographically confirmed neonatal seizures.
• Evaluation of seven specific anticonvulsant drugs: phenobarbital, phenytoin, levetiracetam, lidocaine, midazolam, topiramate, and bumetanide.
• Assessment of drug efficacy, safety, tolerability, and pharmacokinetics.

Main Results:

• The review synthesizes current evidence on seven anticonvulsant drugs used for neonatal seizures.
• Significant knowledge gaps exist regarding optimal treatment regimens and evidence-based protocols.
• The need for high-quality randomized controlled trials is highlighted.

Conclusions:

• Effective diagnosis and treatment of neonatal seizures are critical to mitigate poor neurodevelopmental outcomes.
• Current treatment strategies require further validation through rigorous research.
• Randomized controlled trials are essential to develop safe and effective treatment protocols for neonatal seizures.