The report in JAMA Neurology raises the question of whether stopping ASMs after resolution of acute symptomatic neonatal seizures was associated with functional neurodevelopment or epilepsy at 24 months.
University of California, San Francisco researchers and colleagues conducted a comparative effectiveness study of 303 children with neonatal seizures from nine centers to answer the question. Even though 64% of the infants had ASM maintained at hospital discharge, they identified no difference between ASM maintenance and discontinuation groups in functional neurodevelopment or epilepsy. Overall, 13% of children developed epilepsy, including more than one-third with infantile spasms.
“These results support discontinuing ASMs for most neonates with acute symptomatic seizures prior to discharge from the hospital, an approach that may represent an evidence-based change in practice for many clinicians,” the authors advise.
In other words, they suggest that, for most neonates, there is no need to send them home with prescriptions for antiseizure medicine for months longer, for fear seizures may reoccur.
“There is wide variability in how different hospitals and physicians manage care for newborns with seizures,” explained senior author Renée Shellhaas, MD, MS, pediatric neurologist at University of Michigan C.S. Mott Children’s Hospital.
Although neonatal seizures usually resolve within 72 hours, explained lead author and coprincipal investigator Hannah C. Glass, MDCM, MAS, of UC San Francisco’s Benioff Children’s Hospital. “Our findings suggest that staying on antiseizure medication after leaving the hospital doesn’t protect babies from continued seizures or prevent epilepsy and it does not change developmental outcomes,” Dr. Glass added.
The study was conducted over a 3-year period, with two-thirds of babies staying on medication after discharge from the hospital—averaging 4 months of treatment. Another third had antiseizure medicine discontinued before they went home, after just a few days of treatment.
Concerns have been raised about whether longer-term use of antiseizure medicine could expose newborns to potentially neurotoxic effects, which could lower cognitive scores.
Phenobarbital, which slows down brain activity is the most commonly used medication for neonatal seizures, according to the report. It also causes sedation, making it more difficult for the babies to feed and engage in other types of activities important to growth and development.
“We really need to balance the risks of continued medication with benefits to babies’ health,” Dr. Shellhaas says. “If it’s not necessary, then keeping them on medicine could do more harm than good.”
Background information in the article points out that more than 16,000 newborns in the United States experience neonatal seizures each year, with nearly half developing long-term health problems, according to nonprofit organization PCORI, which supported the new study.
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