What is the role of medications in the treatment of neonatal seizures?

Updated: Jul 31, 2019
  • Author: Raj D Sheth, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Answer

Seizure medication concentrations should be monitored during the acute period. These drugs often are discontinued between ages 3 and 6 months if further seizures have not occurred. A trend toward earlier discontinuation has met with good results.

A general recommendation is to use AEDs for 3 months, but electroencephalography may be helpful in deciding when to stop AEDs.

If the patient remains seizure free, then medications may be tapered gradually. If the patient is on 2 AEDs, then one should be tapered first before considering withdrawal of the other.

If seizures recur, then the patient should be placed back on AEDs. Since phenobarbital and phenytoin have disadvantages, including long-term side effects and, for phenytoin, difficulty maintaining levels, other medications may be considered. Some options include levetiracetam, oxcarbazepine, and topiramate.


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