Antiseizure medications for neonatal seizures: Insights from ILAE guidelines

The International League Against Epilepsy (ILAE) has made significant efforts to standardize the management of neonatal seizures by providing evidence-based recommendations for antiseizure medication in neonates. This is important because managing seizures in neonates can be complex, and evidence-based guidelines help clinicians provide the best care. There were six main recommendations. The phenobarbital should be the first- line antiseizure medication regardless of etiology, unless channelopathy is likely the cause for seizures (e.g., due to family history), in this case phenytoin or carbamazepine should be used. Among neonates with seizures not responding to first-line antiseizure medication phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second-line antiseizure medication. In neonates with cardiac disorders, levetiracetam may be the preferred second-line antiseizure medication. This article provides guidelines and consensus-based recommendations for six priority questions related to neonatal seizure management: (1) first-line antiseizure medication, (2) second-line antiseizure medication, (3) duration of antiseizure medication treatment, (4) impact of therapeutic hypothermia on seizure burden in neonates with hypoxic-ischemic encephalopathy (HIE), (5) impact of electrographic seizure treatment on outcome, and (6) administration of pyridoxine.