Diagnosis and Management of Acute Seizures in Neonates

Seizures in newborns are the most frequent manifestation of an acute neurologic dysfunction, but sometimes they can be the early onset of an epileptic encephalopathy, mainly of genetic origin. When neonatal seizures are suspected, a video-encephalographic (EEG) recording is fundamental for correct interpretation of the clinical phenomena to avoid unnecessary anticonvulsant therapy. After a diagnosis of seizures, continuous monitoring is necessary to evaluate seizure burden, to diagnose status epilepticus, to monitor efficacy of anticonvulsant medications, and to form a differential diagnosis with the uncoupling phenomenon. Although the outcome of newborns depends mostly on the underlying etiology, the presence of seizures seems to have a negative prognostic value, especially if the seizures are prolonged. The most common antiepileptic drugs are only partially effective. Phenobarbital is the most used first-line drug with no differences between preterm and full-term newborns. Moderate to severe abnormal background EEG activity and electrographic-only seizures seem to be associated with a lack of response to phenobarbital. Moreover, seizures management in newborns has not significantly changed if the etiology is acute symptomatic. However, evidence of promising therapeutic approaches for neonatal epilepsy encephalopathies is growing. An accurate and prompt diagnosis of seizures is required for early management to avoid the potential detrimental effects of seizures on the immature brain.