TY - JOUR
T1 - Effectiveness of sodium channel blockers in treating neonatal seizures due to arterial ischemic stroke
AU - Pegoraro, Veronica
AU - Viellevoye, Renaud
AU - Malfilatre, Geneviève
AU - Dilena, Robertino
AU - Proietti, Jacopo
AU - Mauro, Isabella
AU - Zardini, Cecilia
AU - Dzietko, Mark
AU - Lacan, Laure
AU - Desnous, Beatrice
AU - Cordelli, Duccio Maria
AU - Campi, Francesca
AU - Da Silva, Monica Reis
AU - Fumagalli, Monica
AU - Nguyen The Tich, Sylvie
AU - Felderhoff-Müser, Ursula
AU - Ventura, Giulia
AU - Sartori, Stefano
AU - Benders, Manon
AU - Pittini, Carla
AU - Cavicchiolo, Maria Elena
AU - Milh, Mathieu
AU - Cantalupo, Gaetano
AU - van Maanen, Aline
AU - Tataranno, Maria Luisa
AU - Cilio, Maria Roberta
N1 - Publisher Copyright:
© 2024 International League Against Epilepsy.
PY - 2025/2
Y1 - 2025/2
N2 - Objective: Few studies have evaluated the efficacy of antiseizure medications (ASMs) according to the etiology of neonatal acute provoked seizures. We aimed to investigate the response to ASMs in term/near term neonates with acute arterial ischemic stroke (AIS), as well as the type of seizure at presentation and the monitoring approach. Methods: We retrospectively evaluated neonates from 15 European level IV neonatal intensive care units who presented with seizures due to AIS and were monitored by continuous electroencephalography (cEEG) and/or amplitude-integrated EEG (aEEG) in whom actual recordings, timing, doses, and response to ASMs were available for review. Results: One hundred seven neonates were referred, and 88 were included. Of those, 56 met the criteria for evaluating the treatment response. The mean time to treatment was 7.9 h (SD = 16.4), and the most frequently administered first-line ASM was phenobarbital (PB; 74/88, 84.1%). Seizures were controlled within 24 h from onset of symptoms in 64.3% (36/56) of neonates. Phenytoin (PHT) was effective in almost all neonates in whom it was trialed (24/25, 96.0%), whereas PB was effective in only 22.0% of patients (11/50). Infants treated with PB or PHT as first-line treatment (53/56, 94.6%) showed a higher response rate with PHT (6/6, 100.0%) than with PB (11/47, 23.4%). Monitoring approach and seizure types were evaluated in 88 infants. Forty-six of 88 (52.3%) were monitored with cEEG and 47.7% (42/88) with aEEG, with or without intermittent cEEG. The mean monitoring duration was 65.8 h (SD = 39.21). In 83 of 88 (94.3%) infants, the type of seizure suspected clinically prior to monitoring was confirmed afterward. Unilateral focal clonic seizures were seen in 71 of 88 infants (80.7%), whereas 11 of 88 (12.5%) presented with ictal apneas. Significance: Our findings provide evidence in a large, homogenous cohort that PHT is more effective than PB in treating neonatal acute symptomatic seizures due to AIS.
AB - Objective: Few studies have evaluated the efficacy of antiseizure medications (ASMs) according to the etiology of neonatal acute provoked seizures. We aimed to investigate the response to ASMs in term/near term neonates with acute arterial ischemic stroke (AIS), as well as the type of seizure at presentation and the monitoring approach. Methods: We retrospectively evaluated neonates from 15 European level IV neonatal intensive care units who presented with seizures due to AIS and were monitored by continuous electroencephalography (cEEG) and/or amplitude-integrated EEG (aEEG) in whom actual recordings, timing, doses, and response to ASMs were available for review. Results: One hundred seven neonates were referred, and 88 were included. Of those, 56 met the criteria for evaluating the treatment response. The mean time to treatment was 7.9 h (SD = 16.4), and the most frequently administered first-line ASM was phenobarbital (PB; 74/88, 84.1%). Seizures were controlled within 24 h from onset of symptoms in 64.3% (36/56) of neonates. Phenytoin (PHT) was effective in almost all neonates in whom it was trialed (24/25, 96.0%), whereas PB was effective in only 22.0% of patients (11/50). Infants treated with PB or PHT as first-line treatment (53/56, 94.6%) showed a higher response rate with PHT (6/6, 100.0%) than with PB (11/47, 23.4%). Monitoring approach and seizure types were evaluated in 88 infants. Forty-six of 88 (52.3%) were monitored with cEEG and 47.7% (42/88) with aEEG, with or without intermittent cEEG. The mean monitoring duration was 65.8 h (SD = 39.21). In 83 of 88 (94.3%) infants, the type of seizure suspected clinically prior to monitoring was confirmed afterward. Unilateral focal clonic seizures were seen in 71 of 88 infants (80.7%), whereas 11 of 88 (12.5%) presented with ictal apneas. Significance: Our findings provide evidence in a large, homogenous cohort that PHT is more effective than PB in treating neonatal acute symptomatic seizures due to AIS.
KW - aEEG
KW - antiseizure medications
KW - EEG
KW - neonatal acute ischemic stroke
KW - neonatal seizures
UR - http://www.scopus.com/inward/record.url?scp=85210045443&partnerID=8YFLogxK
U2 - 10.1111/epi.18194
DO - 10.1111/epi.18194
M3 - Article
AN - SCOPUS:85210045443
SN - 0013-9580
VL - 66
JO - Epilepsia
JF - Epilepsia
IS - 2
M1 - 394-406
ER -