Management of difficult to control neonatal seizures

Neonatal seizures are polymorphic and can be difficult to diagnose and treat. They are rarely idiopathic and the occurrence of a seizure in a neonate mandates a search for a symptomatic cause. A longstanding view that the developing brain is less vulnerable to the deleterious effect of seizures has resulted in divergent views on the management of seizures in the neonate. At the same time, a reluctance to involve children in drug trials has restricted search for more efficient anticonvulsants in the management of neonatal seizures. Phenobarbitone and phenytoin, though with a relatively poor therapeutic benefit in the newborn infant, still remain the main anticonvulsants in neonates. There is now convincing evidence that neonatal seizures can have deleterious effects on the growing brain, and thus seizures need to be treated more efficiently.