Neonatal Seizures Treatment & Management

Updated: Jul 30, 2019
  • Author: Raj D Sheth, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Medical Care

Acute neonatal seizures should be treated aggressively, although controversy exists as to the optimal treatment for them. [11, 19]

When clinical seizures are present, a rigorous workup to determine an underlying etiologic cause should be initiated quickly. Electrolyte imbalances should be corrected through a central venous site. Hypocalcemia should be treated cautiously with calcium, since leakage of calcium into subcutaneous tissue can cause scarring.

When an inborn error of metabolism is suspected, discontinue feeding, since feeding may exacerbate the seizures and encephalopathy. Institute intravenous solutions.

Once these issues have been addressed, antiepileptic drug (AED) therapy should be considered. Phenobarbital is the initial drug of choice. If seizures persist, the use of phenytoin should be considered.

Patients with seizures resulting from intracranial hemorrhage should have head circumference measurements performed daily. A rapid increase in head circumference may indicate hydrocephalus.


Seizure Medications

Seizure medication concentrations should be monitored during the acute period. These drugs often are discontinued between ages 3 and 6 months if further seizures have not occurred. A trend toward earlier discontinuation has met with good results.

A general recommendation is to use AEDs for 3 months, but electroencephalography may be helpful in deciding when to stop AEDs.

If the patient remains seizure free, then medications may be tapered gradually. If the patient is on 2 AEDs, then one should be tapered first before considering withdrawal of the other.

If seizures recur, then the patient should be placed back on AEDs. Since phenobarbital and phenytoin have disadvantages, including long-term side effects and, for phenytoin, difficulty maintaining levels, other medications may be considered. Some options include levetiracetam, oxcarbazepine, and topiramate.