Neonatal seizures—diagnostic options and treatment recommendations

Abstract

AbstractSeizures in neonates should prompt rapid evaluation to verify the diagnosis, determine etiology, and initiate appropriate treatment. Neonatal seizure diagnosis requires EEG confirmation and clinical observation alone is insufficient. Although most neonatal seizures are related to acute brain injury, some neonates present early-onset structural or metabolic/genetic epilepsy. Video-EEG monitoring, the gold standard for neonatal seizure detection and quantification, is resource-intensive and often unavailable, with amplitude-integrated EEG offering a reasonable alternative in guiding treatment. Whereas new-generation antiseizure medication (ASM), such as levetiracetam, appear promising, particularly in terms of tolerability, older-generation ASM, such as phenobarbital and phenytoin, are yet to be replaced. Acute treatment should aim at stopping both electroclinical and electrographic-only seizures. In neonates with acute provoked seizures, ASM should be discontinued without tapering after 72 h of seizure freedom and before hospital discharge.