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. 2025 Feb;66(2):394-406.
doi: 10.1111/epi.18194. Epub 2024 Nov 23.

Effectiveness of sodium channel blockers in treating neonatal seizures due to arterial ischemic stroke

Veronica Pegoraro  1 , Renaud Viellevoye  2 , Geneviève Malfilatre  3 , Robertino Dilena  4 , Jacopo Proietti  5   6 , Isabella Mauro  7 , Cecilia Zardini  8 , Mark Dzietko  9 , Laure Lacan  10 , Beatrice Desnous  11 , Duccio Maria Cordelli  12   13 , Francesca Campi  14 , Monica Reis Da Silva  15 , Monica Fumagalli  16   17 , Sylvie Nguyen The Tich  10 , Ursula Felderhoff-Müser  9 , Giulia Ventura  7 , Stefano Sartori  8 , Manon Benders  18 , Carla Pittini  7 , Maria Elena Cavicchiolo  19 , Mathieu Milh  11   20 , Gaetano Cantalupo  5   6 , Aline van Maanen  21 , Maria Luisa Tataranno  18 , Maria Roberta Cilio  1   22
Affiliations

Effectiveness of sodium channel blockers in treating neonatal seizures due to arterial ischemic stroke

Veronica Pegoraro et al. Epilepsia. 2025 Feb.

Abstract

Objective: Few studies have evaluated the efficacy of antiseizure medications (ASMs) according to the etiology of neonatal acute provoked seizures. We aimed to investigate the response to ASMs in term/near term neonates with acute arterial ischemic stroke (AIS), as well as the type of seizure at presentation and the monitoring approach.

Methods: We retrospectively evaluated neonates from 15 European level IV neonatal intensive care units who presented with seizures due to AIS and were monitored by continuous electroencephalography (cEEG) and/or amplitude-integrated EEG (aEEG) in whom actual recordings, timing, doses, and response to ASMs were available for review.

Results: One hundred seven neonates were referred, and 88 were included. Of those, 56 met the criteria for evaluating the treatment response. The mean time to treatment was 7.9 h (SD = 16.4), and the most frequently administered first-line ASM was phenobarbital (PB; 74/88, 84.1%). Seizures were controlled within 24 h from onset of symptoms in 64.3% (36/56) of neonates. Phenytoin (PHT) was effective in almost all neonates in whom it was trialed (24/25, 96.0%), whereas PB was effective in only 22.0% of patients (11/50). Infants treated with PB or PHT as first-line treatment (53/56, 94.6%) showed a higher response rate with PHT (6/6, 100.0%) than with PB (11/47, 23.4%). Monitoring approach and seizure types were evaluated in 88 infants. Forty-six of 88 (52.3%) were monitored with cEEG and 47.7% (42/88) with aEEG, with or without intermittent cEEG. The mean monitoring duration was 65.8 h (SD = 39.21). In 83 of 88 (94.3%) infants, the type of seizure suspected clinically prior to monitoring was confirmed afterward. Unilateral focal clonic seizures were seen in 71 of 88 infants (80.7%), whereas 11 of 88 (12.5%) presented with ictal apneas.

Significance: Our findings provide evidence in a large, homogenous cohort that PHT is more effective than PB in treating neonatal acute symptomatic seizures due to AIS.

Keywords: EEG; aEEG; antiseizure medications; neonatal acute ischemic stroke; neonatal seizures.

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References

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