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[Neonatal seizures: the beginning and interruption of the treatment]
M R Koenigsberger1, F J Caballar-Gonzaga, T Dierkes
1University of Medicine and Dentistry of New Jersey (UMDNJ), Newark 07103, USA.
Insights
Expert consensus suggests treating classical neonatal seizures promptly, while subtle seizures require EEG confirmation. Most experts advocate for early discontinuation of seizure therapy, typically before hospital discharge.
Area of Science:
- Neonatology
- Pediatric Neurology
- Clinical Neurophysiology
Context:
- Neonatal seizures present diagnostic and therapeutic challenges.
- Opinions differ on treatment initiation and cessation criteria.
- Expert consensus is sought to guide clinical practice.
Purpose:
- To establish expert agreement on the management of neonatal seizures.
- To clarify when to initiate and discontinue anti-seizure medication.
- To address controversies in neonatal seizure treatment.
Summary:
- Classical neonatal seizures, defined by clinical and EEG criteria, may be treated before EEG confirmation.
- Subtle neonatal seizures necessitate EEG or video/EEG confirmation prior to therapy.
- A majority of experts favor early termination of seizure therapy, often before nursery discharge.
Impact:
- Provides guidance for clinicians managing neonatal seizures.
- Highlights the importance of EEG confirmation for subtle seizures.
- Suggests a shift towards earlier discontinuation of neonatal seizure treatment.
Abstract:
Opinions vary as to which 'neonatal seizures' should be treated and which should not be. There is also controversy as to when therapy of seizures should be discontinued. A poll taken among a group of eleven experts in these matters concurred in the opinion that classical neonatal seizures, those well established by clinical and EEG criteria, can be treated before confirmatory EEG support is obtained. They also agreed that those movements known as subtle seizures should await EEG or video/EEG confirmation before commencing therapy. Nine of these experts now believe that therapy for seizures should be terminated at an early time. Most will stop the therapy while the patient is still in the nursery with the exception of 3 who would treat the babies for 3 months.