Practical Approaches to the Treatment of Neonatal Seizures

Purpose of review This paper critically reviews the current literature and evidence on diagnosis, classification, clinical approach, and management of neonatal seizures. A stepwise approach for the treatment of neonatal seizures is presented. Recent findings In a recent randomized controlled trial comparing phenobarbital to levetiracetam as a first-choice anti-seizure medication with primary outcome seizure free for 24 h, the former was found superior (80% vs 28%, p < 0.001). Summary Neonatal seizures require immediate diagnostic and therapeutic interventions. Phenobarbital is the first-line anti-seizure drug for neonatal seizures, but there is little evidence regarding second-line pharmacotherapy. There is a need for more randomized controlled trials for the use of other existing anti-seizure drugs, yet unlicensed in neonates, and the development of new drugs specifically for neonates.