Neonatal seizures：classification,pathogenesis,and current perspectives in treatment
10.3760/cma.j.issn.1673-4912.2024.10.004
- VernacularTitle:新生儿惊厥诊断分类、发生机制与治疗现状
- Author:
Yi LIN
1
;
Lina MEN
;
Xiuying FANG
;
Hongping LI
;
Weimin HUANG
Author Information
1. 深圳市儿童医院新生儿科 518000
- Keywords:
Seizures;
Newborn;
Classification;
Antiseizure medication
- From:
Chinese Pediatric Emergency Medicine
2024;31(10):738-745
- CountryChina
- Language:Chinese
-
Abstract:
Seizures are a prevalent clinical manifestation during the neonatal period.The majority of neonatal seizures are transient symptoms caused by acute lesions，but in a few cases they are developmental epileptic encephalopathy with neonatal onset.Continuous video-EEG monitoring is the gold standard for diagnosing seizures in newborns,and complex seizures require comprehensive judgment using multi-channel monitoring such as synchronized EMG,blood oxygen,ECG,and respiratory monitoring.In 2021,the International League Against Epilepsy (ILAE) published the updated guidelines for the classification of neonatal seizures,proposing that neonatal seizures cannot be diagnosed if there is only clinical seizure without EEG evidence.Instead,they should be categorized into two types based on the presence of clinical movements and the characteristics of EEG changes during the seizure: electroclinical seizures and electrical seizures.Electroclinical seizures are categorized into motor seizures,non-motor seizures,sequential seizures,and unclassified seizures based on the symptoms exhibited during an attack.In 2023,the ILAE developed evidence-based recommendations for the management of antiseizure medications,discussed the treatment of neonatal seizures based on the latest evidence and emphasized the importance of video EEG in the treatment of neonatal seizures.Phenobarbital remains the first-line antiseizure medication,with phenytoin,levetiracetam,midazolam,or lidocaine as second-line agents.Pyridoxine should be considered for the treatment of neonatal seizures when first- and second-line drugs are ineffective.
