26 Sept 2023 • The Neonatal Task Force of the International League Against Epilepsy (ILAE) has issued a set of evidence-based recommendations for the management of seizures in neonates, addressing the significant variability in management approaches. The task force formulated six priority questions, conducted a systematic review and meta-analysis, and evaluated the quality of evidence following rigorous standards. Their recommendations cover several key aspects of neonatal seizure management.

• Firstly, phenobarbital is recommended as the first-line antiseizure medication (ASM) for neonates, regardless of the cause of seizures.
• However, if a channelopathy is suspected, other options like phenytoin or carbamazepine should be considered.
• Secondly, for neonates not responding to the initial ASM, alternatives such as phenytoin, levetiracetam, midazolam, or lidocaine may be used as second-line options.
• Additionally, therapeutic hypothermia is suggested for reducing seizure burden in neonates with hypoxic-ischemic encephalopathy.
• Treating neonatal seizures to minimize seizure activity may improve outcomes, and pyridoxine can be considered for neonates with features of vitamin B6-dependent epilepsy.
• It's also emphasized that ASMs should be discontinued before discharging neonates without evidence of neonatal-onset epilepsy.

These recommendations aim to provide clarity and consistency in the management of neonatal seizures and promote informed decision-making among healthcare providers.

Source: PracticeUpdate | Read full story