Treatment of neonatal seizures

Newborn babies with unusual movements thought to represent seizures are usually given a loading dose of phenobarbitone without electroencephalography being performed. Antiepileptic drugs (AEDs) are then continued, with the outcome determined by clinical observation alone. AED treatment, often involving multiple drugs for long periods, is undesirable at a time when the brain is developing rapidly and likely to be especially vulnerable to any toxic effects. Despite considerable advances in the pharmacology of AEDs, continuous EEG monitoring using compact digital systems with simultaneous videorecording allowing off-line analysis, automated seizure detection, neuroimaging, and basic science research on cellular mechanisms of brain injury, treatment of such babies has progressed little. A change in practice is long overdue to allow affected babies to benefit from the advances made.