User:Emilyreardon/Neonatal seizure

Studies have identified risk factors for poor outcomes after neonatal seizures. Infants that are premature, have hypoxemic ischemic encephalopathy, CNS infection, severe intraventricular hemorrhage, structural central nervous system defect, or severely abnormal EEG tracings tend to do worse than infants with focal strokes, transient metabolic issues (hypoglycemia, hypocalcemia), or clinical seizures without EEG abnormalities. There are many other risk factors for neonatal seizures. "Some of the risk factors that we have detected, such as low Apgar score, need for resuscitation at birth, and perinatal distress, were previously reported ”. An apgar score indicates how a baby is immediately after birth. Perinatal distress is when a mother experiences a lot of stress during pregnancy. This shows how serious neonatal seizures really are, and not many people knew that.

It is difficult to determine the incidence of seizures in the neonatal period. Estimations range between 1-5 per 1,000 live-births, though the actual rate of seizures during this period may be higher due to lack of accurate diagnosis of sub-clinical seizure activity without continuous EEG monitoring. Acute causes of seizures (hypoxemic ischemic encephalopathy, infection, intracranial hemorrhage, stroke, etc) are more common than first-episode of neonatal epilepsy syndromes. Watching the EEG monitor and detecting when a seizure occurs can help the preterm infant survive through these seizures. "Continuous monitoring and cranial imaging in the setting of neonatal seizures now compromise the standard of care at many centers, and these technologies are being used to guide management, diagnosis, and prognosis ". As the monitoring devices for neonatal seizures become more advanced, the closer researchers are to finding how these seizures occur and how they can be stopped.

If the cause of the seizures are unlikely to be easily or quickly corrected, once diagnosis of a seizure is made, the mainstay of treatment is pharmacotherapy with anti-epileptic drugs. A 2013 systematic review found that most practitioners use phenobarbital or phenytoin. This study found that phenobarbital has the safest side effect profile and longest history of use in neonates. Benzodiazepines are often used as second line treatment if treatment with phenobarbital does not result in clinical improvement. Research is ongoing on use of other anti-epileptics that are commonly used in older children and adults are safe or efficacious to use in neonates. Part of the challenge of anticonvulsant drug treatment during the neonatal period is that the immature excitatory and inhibitory neurotransmitter system results in few effective drug targets. There are some drugs that are effective in controlling seizures. "Phenobarbitone remains the first line treatment for seizures in most countries throughout the world, though off-label use of newer anticonvulsants is widespread in the USA ”. The United States prefers to use unprescribed drugs to help slow down neonatal seizures, but they also use prescribed drugs if needed. Drugs are the only option infants are given, even though they are not 100% effective, they are the best option in helping take control of the seizures to stop them from occurring.