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Review
. 2022 Mar;89(3):245-253.
doi: 10.1007/s12098-021-04039-2. Epub 2022 Jan 20.

Neonatal Seizures-Perspective in Low-and Middle-Income Countries

Hemadri Vegda  1   2 , Vaisakh Krishnan  1   3 , Gabriel Variane  4 , Vaishnavi Bagayi  1   5 , Phoebe Ivain  6 , Ronit M Pressler  7   8
Affiliations
Review

Neonatal Seizures-Perspective in Low-and Middle-Income Countries

Hemadri Vegda et al. Indian J Pediatr. 2022 Mar.

Abstract

Neonatal seizures are the commonest neurological emergency and are associated with poor neurodevelopmental outcome. While they are generally difficult to diagnose and treat, they pose a significant clinical challenge for physicians in low- and middle-income countries (LMIC). They are mostly provoked seizures caused by an acute brain insult such as hypoxic-ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the central nervous system, or acute metabolic disturbances. Early onset epilepsy syndromes are less common. Clinical diagnosis of seizures in the neonatal period are frequently inaccurate, as clinical manifestations are difficult to distinguish from nonseizure behavior. Additionally, a high proportion of seizures are electrographic-only without any clinical manifestations, making diagnosis with EEG or aEEG a necessity. Only focal clonic and focal tonic seizures can be diagnosed clinically with adequate diagnostic certainty. Prompt diagnosis and timely treatment are important, with evidence suggesting that early treatment improves the response to antiseizure medication. The vast majority of published studies are from high-income countries, making extrapolation to LMIC impossible, thus highlighting the urgent need for a better understanding of the etiologies, comorbidities, and drug trials evaluating safety and efficacy in LMIC. In this review paper, the authors present the latest data on etiology, diagnosis, classification, and guidelines for the management of neonates with the emphasis on low-resource settings.

Keywords: EEG; Low- and middle-income countries; Neonatal seizure; Treatment.

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Conflict of interest statement

Ronit M. Pressler has served as an investigator for studies with UCB and Johnson & Johnson. She has received honoraria for educational symposia, advisory boards, and consultancy work from GW Pharma, Natus, UCB, and Esai. She is consulting for Kephala. Gabriel Variane works for Protecting Brains and Saving Futures (PBSF).

Figures

Fig. 1
Fig. 1
ILAE neonatal seizure classification: diagnostic framework of seizures in the neonatal period including a classification of seizures. *If no EEG available, refer to global alignment of immunization safety assessment in pregnancy levels of diagnostic certainty. Reprinted with permission from [17]
Fig. 2
Fig. 2
Neonatal seizures treatment algorithm. If no reduction in seizure burden, change to next-line antiseizure drug if clear effect but seizures still ongoing add on next antiseizure drug. iv Intravenous; sz Seizures
Fig. 3
Fig. 3
Algorithm for discontinuation antiseizure medication in the neonatal period. If seizures persist for > 7 d, consider discharging on 1–2 AMS with optimized efficacy. ASM antiseizure medication; dashed line: consider action within clinical context
See this image and copyright information in PMC

Comment in

  • Changing Paradigms in Neonatal Care.
    Bhat BV. Bhat BV. Indian J Pediatr. 2022 Mar;89(3):243-244. doi: 10.1007/s12098-021-04043-6. Epub 2022 Jan 21. Indian J Pediatr. 2022. PMID: 35061206 No abstract available.

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