Acute symptomatic seizures in newborns: a narrative review

Acute symptomatic seizures are the main sign of neurological dysfunction in newborns. This is linked to the unique characteristics of the neonatal brain, making it hyperexcitable compared to older ages, and to the common occurrence of some forms of acquired brain injury, namely hypoxic-ischemic encephalopathy. In this narrative review we will provide an overview of neonatal seizures definition, their main underlying etiologies, diagnostic work-up and differential diagnoses, and will discuss about therapeutic options and prognostic outlook. The latest publications from the ILAE Task Force on Neonatal Seizures will be presented and discussed. Of note, they highlight the current lack of robust evidence in this field of clinical neurology. We will also report on specificities pertaining to low-and-middle income countries in terms of incidence, main etiologies and diagnosis. The possibilities offered by telemedicine and automated seizures detection will also be summarized in order to provide a framework for future directions in seizures diagnosis and management with a global perspective. Many challenges and opportunities for improving identification, monitoring and treatment of acute symptomatic seizures in newborns exist. All current caveats potentially represent different lines of research with the aim to provide better care and reach a deeper understanding of this important topic of neonatal neurology.