Affiliations: Department of Pediatrics, Division of Newborn
Medicine, Washington University in St Louis, MO, USA | Department of Neurology, Washington University in St
Louis, MO, USA
Note: [] Correspondence: Russell Lawrence, MD, Department of Pediatrics,
Division of Newborn Medicine, 8{th} floor, Northwest Tower, 1 Children's place,
St Louis, MO 63105, USA. E-mail: Lawrence_R@kids.wustl.edu
Abstract: Seizures, a common clinical manifestation of neurological
dysfunction in the neonate, occur in 1–4 per 1000 live births and are
associated with very poor outcomes. However, the role of seizures as merely
associative or contributory to poor outcomes remains unclear. Clinical and
laboratory studies have demonstrated a deleterious effect of seizures on the
developing brain. There is a lack of consensus among the neonatal and
neurologic community about how to monitor and treat patients at risk for
seizures. Currently used antiepileptic drugs lack efficacy and may potentially
cause apoptosis in the developing brain. Continuous conventional
electroencephalography with video is the gold standard for detection and
monitoring of electrographic seizures but may not be practical in a study
design or 24 h widespread clinical use. New drugs such as bumetanide,
levetiracetam, and topiramate hold promise as new therapies, but safety,
pharmacokinetic, and efficacy data remain limited. In this article, current
challenges in designing seizure trials are discussed including potential
options to accurately assess the seizure burden, possible antiepileptic drug
choices, and potential outcome measures. Ongoing trials in the field of
neonatal seizures are also discussed including two separate drug trials and a
multicenter trial evaluating the impact of subclinical seizure treatment using
limited channel amplitude-integrated electroencephalography.
