This is the pre-peer reviewed version of the following article: Effectiveness of sodium channel blockers in treating neonatal seizures due to arterial ischemic stroke, which has been published in final form at https://doi.org/10.1111/epi.18194. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
[en] 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.
Disciplines :
Pediatrics
Author, co-author :
Pegoraro, Veronica ; Department of Pediatrics, Division of Pediatric Neurology, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
Viellevoye, Renaud ; Centre Hospitalier Universitaire de Liège - CHU > > Service néonatologie (CHR)
Malfilatre, Geneviève; Neonatal Intensive Care Unit, CHU Tivoli, La Louvière, Belgium
Dilena, Robertino; Department of Clinical Neurophysiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
Proietti, Jacopo ; Department of Maternal and Child Health, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy ; Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
Mauro, Isabella; Department of Maternal and Child Health, Friuli Centrale Health University Authority, Udine, Italy
Zardini, Cecilia; Department of Women's and Children's Health, Division of Pediatric Neurology and Neurophysiology, University of Padua, Padua, Italy
Dzietko, Mark; Department of Pediatrics I, Neonatal Intensive Care Unit, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Lacan, Laure; Department of Pediatric Neurology, Centre Hospitalier Régional Universitaire (CHRU) Lille University Hospital, Lille, France
Desnous, Beatrice; Department of Pediatric Neurology, Hôpital "La Timone" Enfants, University of Aix-Marseille, Marseille, France
Cordelli, Duccio Maria; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Delle Scienze Neurologiche di Bologna, Unità Operativa Complessa (UOC) Neuropsichiatria dell'età Pediatrica, Bologna, Italy ; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Campi, Francesca; Clinical and Academic Area Fetal-Neonatal and Cardiological Sciences, Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
Da Silva, Monica Reis; Department of Pediatrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Fumagalli, Monica; Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy ; University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
Nguyen The Tich, Sylvie; Department of Pediatric Neurology, Centre Hospitalier Régional Universitaire (CHRU) Lille University Hospital, Lille, France
Felderhoff-Müser, Ursula; Department of Pediatrics I, Neonatal Intensive Care Unit, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Ventura, Giulia; Department of Maternal and Child Health, Friuli Centrale Health University Authority, Udine, Italy
Sartori, Stefano ; Department of Women's and Children's Health, Division of Pediatric Neurology and Neurophysiology, University of Padua, Padua, Italy
Benders, Manon; Department of Neonatology, University Medical Center, Utrecht Brain Center and Wilhelmina Children's Hospital, Utrecht University, Utrecht, the Netherlands
Pittini, Carla; Department of Maternal and Child Health, Friuli Centrale Health University Authority, Udine, Italy
Cavicchiolo, Maria Elena; Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
Milh, Mathieu ; Department of Pediatric Neurology, Hôpital "La Timone" Enfants, University of Aix-Marseille, Marseille, France ; Institut National de la Santé et de la Recherche Médicale, Faculté Des Sciences Médicales et Paramédicales de la Timone, Aix-Marseille Université, Marseille, France
Cantalupo, Gaetano ; Department of Maternal and Child Health, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy ; Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
van Maanen, Aline; Statistical Support Unit, Saint-Luc University Hospital, Brussels, Belgium
Tataranno, Maria Luisa; Department of Neonatology, University Medical Center, Utrecht Brain Center and Wilhelmina Children's Hospital, Utrecht University, Utrecht, the Netherlands
Cilio, Maria Roberta ; Department of Pediatrics, Division of Pediatric Neurology, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium ; Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
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