Neonatal Seizures Medication

Updated: Sep 06, 2017
  • Author: Raj D Sheth, MD; Chief Editor: Amy Kao, MD  more...
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Medication

Medication Summary

Administration of antiepileptic medications should be instituted in an orderly and efficient manner. [20] 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.

Levetiracetam can be effective for patients who do not respond to trandtional AEDs. In 2010, levetiracetam was designated as an orphan drug for neonatal seizures by the FDA. Levetiracetam can be given intravenously. [21]

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Anticonvulsants, Other

Class Summary

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

Phenobarbital

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, in order to minimize respiratory distress. 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.

Levetiracetam (Keppra)

Antiepileptic mechanism unknown. It may inhibit voltage-depedent N-type calcium channels. Levetiracetam may bind to synaptic proteins that modulate neurotransmitter release, and through displacement of negative modulators may facilitate GABA-ergic inhibitory transmission. It is designated as an orphan drug by the FDA for treatment of neonatal seizures.

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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 may respond immediately to pyridoxine.

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