Response to antiseizure medications in neonates with acute symptomatic seizures

Hannah C Glass; Janet S Soul; Catherine J Chu; Shavonne L Massey; Courtney J Wusthoff; Taeun Chang; Maria Roberta Cilio; Sonia L Bonifacio; Nicholas S Abend; Cameron Thomas; Monica Lemmon; Charles E McCulloch; Renée A Shellhaas; Neonatal Seizure Registry study group

doi:10.1111/epi.14671

Response to antiseizure medications in neonates with acute symptomatic seizures

Epilepsia. 2019 Mar;60(3):e20-e24. doi: 10.1111/epi.14671. Epub 2019 Feb 20.

Authors

Affiliations

¹ Departments of Neurology and Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
² Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California.
³ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
⁵ Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁶ Departments of Neurology and Pediatrics, Stanford University, Palo Alto, California.
⁷ Department of Neurology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia.
⁸ Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
⁹ Departments of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁰ Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
¹¹ Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
¹² Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.

Abstract

In a prospective cohort of 534 neonates with acute symptomatic seizures, 66% had incomplete response to the initial loading dose of antiseizure medication (ASM). Treatment response did not differ by gestational age, sex, medication, or dose. The risk of incomplete response was highest for seizures due to intracranial hemorrhage and lowest for hypoxic-ischemic encephalopathy, although the difference was not significant after adjusting for high seizure burden and therapeutic hypothermia treatment. Future trial design may test ASMs in neonates with all acute symptomatic seizure etiologies and could target neonates with seizures refractory to an initial ASM.

Keywords: AED; antiepileptic drug; electroencephalogram; epilepsy; hypoxic-ischemic encephalopathy; neonatal encephalopathy; neonatal seizures; neurocritical care; seizure.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Anticonvulsants / therapeutic use*
Brain / physiopathology
Electroencephalography
Female
Humans
Infant, Newborn
Infant, Newborn, Diseases / drug therapy*
Infant, Newborn, Diseases / physiopathology
Male
Prospective Studies
Seizures / drug therapy*
Seizures / physiopathology
Treatment Outcome

Substances

Anticonvulsants

Abstract

Publication types

MeSH terms

Substances

Grants and funding