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Status Epilepticus in the Neonate: Updates in Treatment Strategies

Stephanie Ahrens1, Margie A Ream2, Laurel A Slaughter2

  • 1Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, 611 E Livingston Avenue FB4, Columbus, OH, 43205, USA. Stephanie.ahrens@nationwidechildrens.org.

Current Treatment Options in Neurology
|February 19, 2019
PubMed

Insights

Phenobarbital is still the primary treatment for neonatal seizures, but newer drugs like levetiracetam show promise with fewer side effects. More research is needed to confirm the best treatment strategies for infant seizures.

Area of Science:

  • Neonatal neurology
  • Pediatric pharmacology
  • Epileptology

Background:

  • Neonatal seizures require effective and safe treatment strategies.
  • Limited high-level evidence exists for optimal neonatal seizure management.
  • Phenobarbital, a traditional first-line therapy, has potential neurotoxic effects.

Purpose of the Study:

  • To review recent advancements in neonatal seizure treatment.
  • To focus on literature published since 2013.
  • To evaluate the efficacy and safety of current and emerging therapies for neonatal seizures and status epilepticus.

Main Methods:

  • Systematic literature review focusing on neonatal seizure treatments.
  • Inclusion of data on recurrent seizures due to limited status epilepticus data.
  • Analysis of efficacy, safety, and medication selection trends in Neonatal Intensive Care Units (NICUs).

Main Results:

  • Phenobarbital remains the first-line treatment despite concerns about neurotoxicity.
  • Bumetanide is no longer favored due to lack of efficacy and increased risk of hearing loss.
  • Levetiracetam and topiramate show potential efficacy with improved safety profiles, though data is limited.

Conclusions:

  • Current evidence for neonatal seizure treatment is limited.
  • Newer agents like levetiracetam may offer safer alternatives.
  • Further research is crucial to establish evidence-based guidelines for neonatal seizure management.
Abstract

Keywords:
AnticonvulsantLevetiracetamNeonatal seizuresPhenobarbitalStatus epilepticusTopiramate

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