Neonatal seizures treatment based on conventional multichannel EEG monitoring: an overview of therapeutic options

ABSTRACT

Introduction

Seizures are the main neurological emergency during the neonatal period and are mostly acute and focal. The prognosis mainly depends on the underlying etiology. Conventional multichannel video-electroencephalographic (cEEG) monitoring is the gold standard for diagnosis, but treatment remains a challenge.

Areas covered

This review, based on PubMed search over the last 4 decades, focuses on the current treatment options for neonatal seizures based on cEEG monitoring. There is still no consensus on seizure therapy, owing to poor scientific evidence. Traditionally, the first-line treatments are phenobarbital and phenytoin, followed by midazolam and lidocaine, but their efficacy is limited. Therefore, current evidence strongly suggests the use of alternative antiseizure medications. Randomized controlled trials of new drugs are ongoing.

Expert opinion

Therapy for neonatal seizures should be prompt and tailored, based on semeiology, mirror of the underlying cause, and cEEG features. Further research should focus on antiseizure medications that directly act on the etiopathogenetic mechanism responsible for seizures and are therefore more effective in seizure control.

KEYWORDS:

• Antiseizure medication
• conventional multichannel EEG monitoring
• levetiracetam
• neonatal seizures
• neurodevelopmental outcome
• phenytoin
• phenobarbital
• treatment

Article highlights

• Seizures are the main neurological emergency during the neonatal period, and they are mostly acutely provoked seizures.

• As conventional multichannel video-electroencephalographic monitoring is the gold standard for diagnosis, its routinely use in Neonatal Intensive Care Units must be implemented.

• Neonatal seizures treatment must be prompt and effective, as seizure burden correlates with prognosis.

• Semeiology and features of neonatal seizures on multichannel conventional video-electroencephalographic monitoring should direct clinicians to the most likely etiology.

• Future research will focus on precision medicine.

• Advances in genomic technologies will disclose many other pathogenic variants associated with neonatal seizures.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.