How are seizures treated in infants with hypoxic-ischemic encephalopathy (HIE)?

Updated: Jul 18, 2018
  • Author: Santina A Zanelli, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Hypoxic-ischemic encephalopathy (HIE) is the most common cause of seizures in the neonatal period. Seizures are generally self-limited to the first days after birth but may significantly compromise other body functions, such as maintenance of ventilation, oxygenation, and blood pressure. Additionally, studies suggest that seizures, including asymptomatic electrographic seizures, may contribute to brain injury and increase the risk of subsequent epilepsy. [76, 77, 78]

Current therapies available to treat neonates with seizures have limited efficacy, and safety concerns remain specifically for infants undergoing therapeutic hypothermia. Antiseizure drugs used in this population include phenobarbital, levetiracetam, phenytoin, lidocaine, and benzodiazepines. However, phenobarbital has been shown to be effective in only 29-50% of cases, [79, 80, 81]  and phenytoin only offers an additional 15% efficacy. Benzodiazepines, particularly lorazepam, may offer some additional efficacy. [82, 83]  Newer antiseizure medications such as levetiracetam are increasingly used in infants with HIE and seizures despite the lack of strong evidence regarding safety or efficacy in this population.

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