New evidence supports discontinuation of antiseizure medications in neonates

Epilepsy

By Mardi Chapman

1 Jun 2021

Discontinuation of antiseizure medication (ASM) at discharge after acute symptomatic neonatal seizures appears to be safe.

A comparative effectiveness study of 303 children found most (64%) were maintained on ASM, usually phenobarbital (90%), beyond resolution and discharge.

The US study found the rate of impaired functional neurodevelopment at 24 months was similar in those discontinued and those maintained on ASM (28% vs 37%; odds ratio, 0.6; 95% CI, 0.4-1.1; P = .11).

The study also found the risk of epilepsy did not differ by ASM treatment duration group (11% in ASM discontinued group vs 14% ASM maintained: odds ratio, 0.8; 95% CI, 0.4-1.6; P = .49).

And there was no difference in motor function between infants whose ASM was discontinued versus maintained at hospital discharge (13% vs 19%; odds ratio, 0.6; 95% CI, 0.3-1.3; P = .18).

The study, published in JAMA Neurology, said discontinuation of ASM after resolution of acute seizures and before hospital discharge was safe and supports WHO practice recommendations.

“We expand this recommendation to include all neonates with acute symptomatic seizures, even in the setting of abnormal EEG and neurological examination. Adopting this approach may represent an evidence-based change in practice for many clinicians.”

The researchers said the practice of continuing ASM was established prior to the use of diagnostic EEG and MRI for all neonates with suspected seizures.

“Contemporary neurocritical care management uses cEEG to accurately diagnose seizures and ASM response along with magnetic resonance imaging and genetic testing to determine the cause of seizures, which allows for a tailored management approach.”

An accompanying editorial in the journal said neonatal seizures were usually the sequelae of underlying brain injury such as hypoxic-ischemic encephalopathy, stroke, intracranial hemorrhage, infection or metabolic disorders.

“As a result, infants with neonatal seizures are already at high risk of neurodevelopmental disability long term,” the authors said.

“Antiseizure medication does not mitigate brain injury that has already occurred.”

Instead there was evidence that drug exposure during critical periods of brain development may adversely affect nervous system function thus reinforcing the need to balance harms versus benefits of treatment.

“While neonatal care clinicians seek to avoid unnecessary harm to their vulnerable patients—especially to the rapidly developing brains of their patients—what may constitute unnecessary harm often remains unclear.”

They agreed the study’s findings supported the 2011 WHO guidance.

Already a member?

Login to keep reading.

OR
Email me a login link