Neonatal Seizure Management: Is the Timing of Treatment Critical?

Andreea M Pavel,Janet M Rennie,Linda S De Vries,Mats Blennow,Adrienne Foran,Divyen K Shah,Ronit M Pressler,Olga Kapellou,Eugene M Dempsey,Sean R Mathieson,Elena Pavlidis,Lauren C Weeke,Vicki Livingstone,Deirdre M Murray,William P Marnane,Geraldine B Boylan

doi:10.1016/j.jpeds.2021.09.058

Abstract

ObjectiveTo assess the impact of the time to treatment of the first electrographic seizure on subsequent seizure burden and describe overall seizure management in a large neonatal cohort.Study designNewborns (36-44 weeks of gestation) requiring electroencephalographic (EEG) monitoring recruited to 2 multicenter European studies were included. Infants who received antiseizure medication exclusively after electrographic seizure onset were grouped based on the time to treatment of the first seizure: antiseizure medication within 1 hour, between 1 and 2 hours, and after 2 hours. Outcomes measured were seizure burden, maximum seizure burden, status epilepticus, number of seizures, and antiseizure medication dose over the first 24 hours after seizure onset.ResultsOut of 472 newborns recruited, 154 (32.6%) had confirmed electrographic seizures. Sixty-nine infants received antiseizure medication exclusively after the onset of electrographic seizure, including 21 infants within 1 hour of seizure onset, 15 between 1 and 2 hours after seizure onset, and 33 at >2 hours after seizure onset. Significantly lower seizure burden and fewer seizures were noted in the infants treated with antiseizure medication within 1 hour of seizure onset (P = .029 and .035, respectively). Overall, 258 of 472 infants (54.7%) received antiseizure medication during the study period, of whom 40 without electrographic seizures received treatment exclusively during EEG monitoring and 11 with electrographic seizures received no treatment.ConclusionsTreatment of neonatal seizures may be time-critical, but more research is needed to confirm this. Improvements in neonatal seizure diagnosis and treatment are also needed.

Highlights

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record
Based on the timing of ASM treatment received after electrographic seizure onset: 26(16.9%) infants had ASM given within 1 hour, 23(14.9%) between 1-2 hours and 74(48.1%) after 2 hours
Infants in the group treated within 1 hour had an earlier seizure onset, a longer duration of first electrographic seizure and a higher seizure burden in the first hour after seizure onset, compared with infants in other groups (Table 2)

Summary

Introduction

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. Infants who Journal Pre-proof received anti-seizure medication exclusively after electrographic seizure onset, were grouped based on time to treatment of the first seizure: ASM within 1-hour, ASM between 1-2 hours and ASM after 2-hours.

Results

Conclusion