Neonatal Seizures: Diagnosis, Etiologies, and Management

Julie Ziobro, MD, PhD; Renée A. Shellhaas, MD, MS


Semin Neurol. 2020;40(2):246-256. 

In This Article

Research Priorities

Neonatal seizures are an important risk factor for poor outcomes in both preterm and term infants. There is still significant debate regarding the extent of seizure control necessary to maximize outcomes among survivors of acute symptomatic neonatal seizures, given the natural history of seizure resolution and the possibility of side effects from ASMs. With increased EEG monitoring of high-risk patients, a subset of neonates with neurologic injury and EEG-only seizures have been identified in real time and seizures have been promptly treated. By comparing long-term outcomes of these patients with those whose seizures are detected and treated later in their disease course, or with historic controls of patients with similar risks who did not undergo EEG monitoring, we could better understand the impact of clinical treatments on the developing brain. There remain many clinical questions regarding the need for treatment, type of treatment, and treatment duration of neonatal seizures that will only be answered with high-quality, well-designed clinical studies involving multisite collaboration.

Though genetic epilepsies represent a small proportion of neonatal seizures, increasing understanding of their pathophysiology and ability to provide rapid genetic diagnosis is leading to significant advances in treatment. The goal of precision medicine is to select the most appropriate ASM or disease-modifying therapy for specific genetic diseases. Further characterization of rare genetic epilepsies at a basic science level is essential for development of novel therapies or possible repurposing of available drugs. The future of effective therapies for severe neonatal epilepsies, designed to maximize both immediate seizure control and long-term neurodevelopmental and medical outcomes, may rest on specific gene therapies or the development of sense and antisense oligonucleotides,[77] with a goal of maximizing developmental and medical outcomes in this vulnerable population.