Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. S23-S27 (doi:10.1542/peds.2005-0620D)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Clancy, R. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Clancy, R. R.
Related Collections
Right arrow Premature & Newborn

SUPPLEMENT ARTICLE

Summary Proceedings From the Neurology Group on Neonatal Seizures

Robert R. Clancy, MD

Division of Neurology, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

One of the highest risk periods for seizures during the human life span is the first month of life. Most neonatal seizures are triggered by acute illness such as hypoxic-ischemic encephalopathy, stroke, or infection; rarely are they triggered by epilepsy per se. Seizures are the most common and important sign of acute neonatal encephalopathy, are a major risk for death or subsequent neurologic disability, and by themselves may contribute to an adverse neurodevelopmental outcome. Customary clinical practice includes visual monitoring of high-risk neonates for seizures, performance of a routine electroencephalogram (EEG) for suspicious clinical seizure activity, and empirical treatment with phenobarbital. Presently, however, there are no data that have unequivocally demonstrated the efficacy of barbiturates in the treatment of neonatal seizures. The neurology group recognizes an important need for randomized, placebo-controlled, ethically acceptable trials of phenobarbital efficacy and safety in the treatment of neonatal seizures. After exploring 3 possible frameworks for clinical trials of phenobarbital in the treatment of neonatal seizures, the neurology group ultimately focused on a multicenter, placebo-controlled, electroencephalographer-blinded study of phenobarbital versus placebo in a homogeneous group of newborns who are at high risk of developing early subclinical electroencephalographically detected neonatal seizures. Continuous video-EEG monitoring would establish the presence and number of seizures. Criteria for escape from the study to treatment are clearly defined. The proposed study could provide the first concrete evidence of treatment efficacy because (1) it examines a homogeneous patient population, (2) the recognition and quantification of seizures rests solely on the gold standard of seizure detection (EEG), and (3) the dosing of phenobarbital is matched specifically to the phenobarbital-binding characteristics of the individual treated. This study would affirm or refute the common practice of phenobarbital as the first-line treatment of neonatal seizures.

Key Words: EEG • seizures • congenital heart disease • neonatal seizures • phenobarbital

Abbreviations: HIE—hypoxic-ischemic encephalopathy • EEG—electroencephalogram • ENS—electroencephalographically detected neonatal seizure • ECMO—extracorporeal membrane oxygenation

Accepted Oct 17, 2005.




This article has been cited by other articles:


Home page
 PediatricsHome page
J. M. Freeman
The Use of Amplitude-Integrated Electroencephalography: Beware of Its Unintended Consequences
Pediatrics, March 1, 2007; 119(3): 615 - 617.
[Full Text] [PDF]