Specifics of epilepsy treatment during the first year of life in preterm infants and extremely preterm neonates

Abstract

One of the most important tasks of the modern medical science is neonatal life and health preservation. Achievements in the areas of obstetrical and neonatal assistance have significantly increased the survival rate among extremely preterm neonates at birth. However, monitoring of these children has showed a high level of disability which in the future during the first year of life is often combined with a high morbidity rate and functional disorders. Aim. To study epilepsy treatment during the first year of life in preterm infants and extremely preterm neonates Methods and results. Modern child epilepsy treatment is based on using various standards, protocols and clinical recommendations of the leading national and foreign experts. However, such standards do not take into account the specifics of the nervous system and somatic condition (comorbid background) in a preterm infant and especially in an extremely preterm neonate. Treatment of the seizure syndrome is only one of many aspects of the epilepsy treatment in a preterm infant. It is crucial that the condition of all body systems and organs (other than the nervous system) are taken into account. The discovery of the bronchopulmonary dysplasia, dysfunction of the liver and gastrointestinal tract can create obstacles not only for implementing certain anticonvulsant treatment, but also for the increase of the AEP dose to the medium therapy level and achieving of the clinical remission in epilepsy treatment. In order to survey the effectiveness and tolerance rate of the anti-epileptic therapy in preterm children with epilepsy (taking into account the somatic condition), 100 children in the age range between 1 month and 3 years have been monitored. The form of epilepsy was determined based on the specifics in the course of seizures and the disease in whole. Conclusions. It is important to consider the condition of body organs and systems other than the nervous system during treatment of preterm children of young age with epilepsy and especially extremely preterm neonates. Bronchopulmonary dysplasia, liver and gastrointestinal tract dysfunction evolving can prevent not only the implementation of the anticonvulsant therapy, but also the increase of the AEP dose to the medium therapy level. Medical treatment of extremely preterm neonates aimed at achieving the clinical remission of the epileptic attacks. The percentage of the epilepsy treatment resistant cases in extremely preterm neonates with epilepsy is significantly higher as compared to very preterm neonates with the body weight above 1000 grams (52% as compared to 34%). Such high percentage is a result of not so much of the severely damaged nervous system in such children, but to a larger extent as a result of the inability to prescribe the whole specter of the anti-seizure therapy and their respective dosages in order not to harm the child’s body. For this group of children one needs to develop an individual approach and therapy strategy based on the adequate medical treatment with anticonvulsants, their doses and frequency during a day. The prospects of this research include further analysis of the impact of anticonvulsant therapy on the course of epilepsy in preterm children.