IEC 2025 | Treatment approaches for neonatal seizures: first- and second-line options
Elissa Yozawitz, MD, Children’s Hospital at Montefiore, New York City, NY, comments on the treatment of neonatal seizures, stating that phenobarbital is a first-line medication that works well in the acute setting. Prof. Yozawitz notes that more research needs to be done to identify the optimal second-line approach, which currently includes fosphenytoin and levetiracetam. This interview took place at the 36th International Epilepsy Congress (IEC) in Lisbon, Portugal.
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Transcript
So with treatment, we’re learning. And one of the first-line medications we use for neonatal seizures is one of the oldest medications we have. So phenobarbital. It’s a great medicine. It works very well for neonatal seizures. And we use it acutely in the acute setting. We have very limited double-blind placebo-controlled trials and as we’re learning more, we need to learn more to figure out what the most second-line medication is, but for first line, we use phenobarbital and we use it for acute provoked seizures, just in the acute setting...
So with treatment, we’re learning. And one of the first-line medications we use for neonatal seizures is one of the oldest medications we have. So phenobarbital. It’s a great medicine. It works very well for neonatal seizures. And we use it acutely in the acute setting. We have very limited double-blind placebo-controlled trials and as we’re learning more, we need to learn more to figure out what the most second-line medication is, but for first line, we use phenobarbital and we use it for acute provoked seizures, just in the acute setting. We found that stopping the medication prior to them going home does not prevent the development of epilepsy down the line. So we typically, if they’re not having seizures, we stop it regardless of EEG and MRI and the baby, we wait for the baby to declare themselves if they’re going to have seizures or not down the line. Second line is still up in the air, but we use phenytoin or fosphenytoin, levetiracetam. And we, depending on what we think the etiology is, if you think it’s more of a channelopathy, we’ll use the sodium channel blockers first. If they have a cardiac impairment, we’ll use levetiracetam first because that’s less harmful to the heart. And as we determine the etiology with some of the epilepsy syndromes, we know the channelopathies, as I said before, respond better to the sodium channel blockers. So we would use those first line. And I think as we learn more about the genetics and targeted gene therapies, that’s going to play a role in the future. So there’s still a lot to be learned about the treatments of neonatal seizures, but we’re getting there. We’re comfortable with the first line, phenobarbital seems to work the best. We’re learning more about second line and hopefully we’ll continue to learn more in the future.
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