Which medications in the drug class Anticonvulsants, Other are used in the treatment of Neonatal Seizures?

Answer

Anticonvulsants, Other

These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.

Phenobarbital

It is important to use the minimal amount of phenobarbital required and to wait for the anticonvulsant effect to develop before a second dose is given, in order to minimize respiratory distress. Start with the loading dose and continue with the maintenance dosage.

Phenytoin (Dilantin, Phenytek)

Phenytoin should be added to phenobarbital if seizures persist. Phenytoin may act in the motor cortex, where it may inhibit the spread of seizure activity. The activity of brain-stem centers responsible for the tonic phase of grand mal seizures also may be inhibited.

Lorazepam (Ativan)

Lorazepam is a benzodiazepine anticonvulsant. It is used in cases refractory to phenobarbital and phenytoin. By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, lorazepam may depress all levels of the CNS, including the limbic and reticular formations.

Levetiracetam (Keppra)

Antiepileptic mechanism unknown. It may inhibit voltage-depedent N-type calcium channels. Levetiracetam may bind to synaptic proteins that modulate neurotransmitter release, and through displacement of negative modulators may facilitate GABA-ergic inhibitory transmission. It is designated as an orphan drug by the FDA for treatment of neonatal seizures.

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Media Gallery

Onset of neonatal seizure demonstrating a focal onset in the right frontal (FP4) region. At this point, the child had head and eye deviation to the left.
Twenty seconds into a seizure that had focal onset in the right frontal (FP4) region, the seizure shows a rhythmic buildup of activity in the right frontocentral region.
This seizure had focal onset in the right frontal (FP4) region and subsequent buildup of activity in the right frontocentral region. As the seizure evolves, the electroencephalogram shows diffuse involvement of both cerebral hemispheres.

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Author

Raj D Sheth, MD Chief, Division of Pediatric Neurology, Nemours Children's Clinic; Professor of Neurology, Mayo Clinic Alix School of Medicine; Professor of Pediatrics, University of Florida College of Medicine

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, Child Neurology Society

Disclosure: AAN reviewer, ACNS Ed board, Infantile spasms consultant for: AAN; ACNS; Mackilrodt.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP Chief of Pediatric Neurology, Professor of Pediatrics, Neurology, Neurosurgery, and Psychiatry, Epileptologist, Medical Director, Tulane Center for Autism and Related Disorders, Co-Director, Developmental Neurogenetics Center, Tulane University School of Medicine

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Medical Association, Association of Military Surgeons of the US, Child Neurology Society, Southern Pediatric Neurology Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Biomarin; Supernus<br/>Received income in an amount equal to or greater than $250 from: Biomarin; Supernus, Sunovion; American Board of Pediatrics.

Acknowledgements

Robert Stanley Rust Jr, MD, MA Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Which medications in the drug class Anticonvulsants, Other are used in the treatment of Neonatal Seizures?

Anticonvulsants, Other

Phenobarbital

Phenytoin (Dilantin, Phenytek)

Lorazepam (Ativan)

Levetiracetam (Keppra)

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