Neonatal Seizures and Response to Phenobarbitone: A Three-Year Single-Center Experience

Background/Purpose: Neonatal seizures are the most common neurological emergency on neonatal intensive care units (NICU). Phenobarbitone is the mainstay treatment for neonatal seizures. Recently there has been a strong trend toward levetiracetam becoming the first-line drug. This is due to reported low response rates and concerns about neuronal apoptosis following phenobarbitone treatment. We aimed to analyze seizure treatment and response rates to phenobarbitone in our center.

Methods: Retrospective analysis of neonates with clinical and/or electrophysiological seizures admitted to our NICU between 2012 and 2015. Patients’ files were reviewed by one neonatologist and one child neurologist to confirm the diagnosis of neonatal seizures. Data on demographics, day and mode of seizure presentation, etiology, type, dosage and duration of treatment, and treatment response were obtained.

Results: Twenty newborns with neonatal seizures detected within 72 hours after birth were identified. Etiology was diverse. First-line medication was phenobarbitone (n = 19) or levetiracetam (n = 1). After initial phenobarbitone, cessation of seizures was seen in 14 of 19 neonates (64%). Phenobarbitone drug levels were < 50mg/dl in all. Nonresponders were patients with severe HIE (n = 1), severe metabolic disease (n = 3), and epileptic encephalopathy (n = 1) also resistant to later add-on antiepileptic drugs. One newborn was treated with levetiracetam alone.

Conclusion: Response to phenobarbitone is usually good. Non-responders were those with severe underlying disease also resistant to second and third line drugs, including levetiracetam. Until more is known about long term effects of neonatal levetiracetam treatment, phenobarbitone should remain first choice for seizure treatment in neonates.