Abstract
Seizures are the most common neurological emergency in the neonates, and this age
group has the highest incidence of seizures compared with any other period of life.
The author provides a narrative review of recent advances in the genetics of neonatal
epilepsies, new neonatal seizure classification system, diagnostics, and treatment
of neonatal seizures based on a comprehensive literature review (MEDLINE using PubMED
and OvidSP vendors with appropriate keywords to incorporate recent evidence), personal
practice, and experience. Knowledge regarding various systemic and postzygotic genetic
mutations responsible for neonatal epilepsy has been exploded in recent times, as
well as better delineation of clinical phenotypes associated with rare neonatal epilepsies.
An International League Against Epilepsy task force on neonatal seizure has proposed
a new neonatal seizure classification system and also evaluated the specificity of
semiological features related to particular etiology. Although continuous video electroencephalogram
(EEG) is the gold standard for monitoring neonatal seizures, amplitude-integrated
EEGs have gained significant popularity in resource-limited settings. There is tremendous
progress in the automated seizure detection algorithm, including the availability
of a fully convolutional neural network using artificial machine learning (deep learning).
There is a substantial need for ongoing research and clinical trials to understand
optimal medication selection (first line, second line, and third line) for neonatal
seizures, treatment duration of antiepileptic drugs after cessation of seizures, and
strategies to improve neuromorbidities such as cerebral palsy, epilepsy, and developmental
impairments. Although in recent times, levetiracetam use has been significantly increased
for neonatal seizures, a multicenter, randomized, blinded, controlled phase IIb trial
confirmed the superiority of phenobarbital over levetiracetam in the acute suppression
of neonatal seizures. While there is no single best choice available for the management
of neonatal seizures, institutional guidelines should be formed based on a consensus
of local experts to mitigate wide variability in the treatment and to facilitate early
diagnosis and treatment.
Keywords
neonatal seizures - epilepsy - amplitude-integrated EEG - treatment - phenobarbital
- levetiracetam
