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Clinical and EEG response to anticonvulsants in neonatal seizures
J Connell1, R Oozeer, L de Vries
1Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Insights
Common anticonvulsant drugs show limited effectiveness in controlling neonatal seizures and improving neurological outcomes. Continuous electroencephalographic (EEG) monitoring is crucial for accurate diagnosis and further research in neonatal seizures.
Area of Science:
- Neonatal neurology
- Clinical neurophysiology
Background:
- Neonatal seizures are a significant concern with often poor neurological outcomes.
- The clinical presentation of neonatal seizures can be variable and difficult to discern.
- The efficacy of traditional anticonvulsant drugs in this population is questionable.
Purpose of the Study:
- To evaluate the effectiveness of common anticonvulsant drugs in treating neonatal seizures.
- To assess the impact of these treatments on neurological outcomes.
- To determine the role of continuous electroencephalographic (EEG) monitoring in neonatal seizure management.
Main Methods:
- Prospective continuous EEG monitoring of 275 infants over two years.
- Identification of seizure activity in 55 infants, with 31 treated with anticonvulsants.
- Comparison of clinical and EEG response, and neurological outcomes between treated and untreated groups.
Main Results:
- Only 8 out of 31 treated infants showed a complete or equivocal EEG and clinical response.
- 13 treated infants had clinical response but persistent EEG seizures; 10 showed no response.
- No significant improvement in neurological outcome was observed in treated infants compared to untreated ones.
- Background EEG abnormalities predicted poor treatment response and worse clinical outcomes.
Conclusions:
- Commonly used anticonvulsant drugs have minimal effect on seizure control and neurological outcome in neonatal seizures linked to cerebral lesions.
- Continuous EEG monitoring is essential for accurate diagnosis and should be a standard in future studies of neonatal anticonvulsant treatment.
- Background EEG abnormalities are significant predictors of treatment response and long-term outcomes.
Abstract:
During a two year period prospective continuous electroencephalographic (EEG) monitoring of 275 infants identified seizure activity in 55 cases, 31 of whom were treated with anticonvulsant drugs on clinical grounds. EEG and clinical response was complete in only two and equivocal in another six. Clinical response with persistent EEG seizures occurred in 13 and neither clinical nor EEG response in 10. There was no significant improvement in the generally poor neurological outcome compared with that in 24 infants whose seizures were not treated because of limited or absent clinical manifestations. Background EEG abnormality (as an index of associated cerebral dysfunction) was a guide to potential lack of response to anticonvulsant drugs; it was also predictive of subsequent clinical outcome irrespective of treatment. This study shows that commonly used anticonvulsant drugs (phenobarbitone, paraldehyde, phenytoin, and diazepam) have little effect on seizure control or neurological outcome in neonatal seizures associated with haemorrhagic, hypoxic, or ischaemic cerebral lesions. In view of the variable clinical appearance of EEG seizure activity, continuous EEG monitoring should be an essential feature of further study of neonatal anticonvulsant treatment.