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Neonatal Seizures Medication

  • Author: Raj D Sheth, MD; Chief Editor: Amy Kao, MD  more...
Updated: Apr 15, 2016

Medication Summary

Administration of antiepileptic medications should be instituted in an orderly and efficient manner.[18] Initial treatment with phenobarbital should be considered. If seizures persist, phenytoin should be added. Persistent seizures may require the use of an intravenous benzodiazepine, such as lorazepam or midazolam.

As previously stated, 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. Hypoglycemia, if present, should be corrected.


Anticonvulsants, Other

Class Summary

These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.



It is important to use the minimal amount of phenobarbital required and to wait for the anticonvulsant effect to develop before a second dose is given. Start with the loading dose and continue with the maintenance dosage.

Phenytoin (Dilantin, Phenytek)


Phenytoin should be added to phenobarbital if seizures persist. Phenytoin may act in the motor cortex, where it may inhibit the spread of seizure activity. The activity of brain-stem centers responsible for the tonic phase of grand mal seizures also may be inhibited.

Lorazepam (Ativan)


Lorazepam is a benzodiazepine anticonvulsant. It is used in cases refractory to phenobarbital and phenytoin. By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, lorazepam may depress all levels of the CNS, including the limbic and reticular formations.


Vitamins, Water-Soluble

Class Summary

Pyridoxine may be effective in seizures that are refractory to the medications already discussed. It is essential for normal deoxyribonucleic acid (DNA) synthesis and cell function.

Pyridoxine (Aminoxin, Pyri-500)


Pyridoxine should be tried in patients not responding to the above regimen. Patients with pyridoxine-dependent seizures respond immediately to pyridoxine.

Contributor Information and Disclosures

Raj D Sheth, MD Chief, Division of Pediatric Neurology, Nemours Children's Clinic; Professor of Neurology, Mayo College of Medicine; Professor of Pediatrics, University of Florida College of Medicine

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, Child Neurology Society

Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from Express Scripts.


Robert Stanley Rust Jr, MD, MA Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Onset of neonatal seizure demonstrating a focal onset in the right frontal (FP4) region. At this point, the child had head and eye deviation to the left.
Twenty seconds into a seizure that had focal onset in the right frontal (FP4) region, the seizure shows a rhythmic buildup of activity in the right frontocentral region.
This seizure had focal onset in the right frontal (FP4) region and subsequent buildup of activity in the right frontocentral region. As the seizure evolves, the electroencephalogram shows diffuse involvement of both cerebral hemispheres.
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