Rethinking the definition of neonatal status epilepticus.

Area of Science:

• Neonatal Neurology
• Epileptology
• Critical Care Pediatrics

Background:

• The historical definition of neonatal status epilepticus (NSE) requires seizures lasting ≥ 30 minutes, which may not reflect the neonatal brain's unique pathophysiology.
• Current definitions may not adequately capture the clinical context of acute symptomatic seizures in neonates.
• Continuous monitoring has led to the preferential use of "high seizure burden" definitions.

Purpose of the Study:

• To critically examine existing and emerging conceptual approaches for defining neonatal status epilepticus (NSE).
• To address the need for a more specific and context-appropriate definition of NSE in the neonatal period.
• To inform future research and clinical care for critically ill newborns experiencing seizures.

Main Methods:

• Literature review of conceptual approaches to defining NSE.
• Examination of outcome-based definitions.
• Analysis of definitions based on spontaneous seizure termination likelihood and antiseizure medication response.

Main Results:

• Three conceptual approaches for defining NSE were critically examined: outcome-based, spontaneous termination, and drug response.
• Emerging evidence suggests definitions tailored to neonatal-specific mechanisms are needed.
• A proposed definition considers any single seizure lasting 5 minutes as early NSE.

Conclusions:

• Existing knowledge gaps in defining NSE are being addressed by emerging evidence.
• A definition grounded in neonatal-specific mechanisms and clinical realities is crucial.
• Improved NSE definitions hold promise for enhancing neurodevelopmental outcomes in neonates.