Recognition and management of neonatal seizures

Seizures are the most common major manifestation of central nervous system dysfunction in the newborn. There are many causes, but perinatal asphyxia and haemorrhagic/infarction lesions account for about 75%. There is now considerable evidence that frequent but short seizures in the neonate affect subsequent neurodevelopmental outcome. Studies using EEG or modified continuous tracing of EEG activity (aEEG or CFM) have shown that there is often electroconvulsive dissociation. This refers to poor correlation between electrical seizures and clinical seizures. Commonly used anticonvulsants appear to increase electroconvulsive dissociation. Effective management of neonatal seizures has proved very disappointing and less than 50% of seizures are abolished by first-line anticonvulsant medication (phenobarbitone or phenytoin). Drugs such as midazolam and lidocaine may further reduce seizures but require more evaluation. The challenge is to assess new and more effective anticonvulsants which are themselves associated with little neurotoxicity.