Neonatal seizure recurrence following discontinuation of phenobarbital

The recurrence of seizures in neonates following discontinuation of phenobarbital was studied. All neonates treated for seizures in the intensive care nursery over a period of four years were followed for seizure recurrence after discharge from the hospital. Of 64 neonates treated for seizures, 50 were followed until they were at least 12 months of age. Their charts were reviewed for birth date, birth weight, gestational age, Apgar scores, age at seizure onset, seizure type, seizure etiology, duration of anticonvulsant therapy, and any neurologic deficits. Information on seizure activity and neurologic and developmental status was obtained through clinic observation or telephone interviews with parents and pediatricians. Anticonvulsant therapy was continued for 4 to 97 days; however, 85% of patients were treated less than three weeks. Those treated longer than three weeks either could not be withdrawn from anticonvulsants or were premature infants who had prolonged, severe illness. The length of follow-up ranged from 12 to 47 months, the average follow-up age being 24 months. Six patients were found to require long-term anticonvulsants because of persistent or recurring seizures. The severity of neurologic damage was a good predictor of seizure recurrence. The duration of anticonvulsant therapy in neonates should be limited to the period when the neonate is acutely ill.