Effectiveness of sodium channel blockers in treating neonatal seizures due to arterial ischemic stroke.

IF 6.6 1区医学 Q1 CLINICAL NEUROLOGY Epilepsia Pub Date : 2024-11-23 DOI:10.1111/epi.18194

Veronica Pegoraro, Renaud Viellevoye, Geneviève Malfilatre, Robertino Dilena, Jacopo Proietti, Isabella Mauro, Cecilia Zardini, Mark Dzietko, Laure Lacan, Beatrice Desnous, Duccio Maria Cordelli, Francesca Campi, Monica Reis Da Silva, Monica Fumagalli, Sylvie Nguyen The Tich, Ursula Felderhoff-Müser, Giulia Ventura, Stefano Sartori, Manon Benders, Carla Pittini, Maria Elena Cavicchiolo, Mathieu Milh, Gaetano Cantalupo, Aline van Maanen, Maria Luisa Tataranno, Maria Roberta Cilio

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Abstract

Objective: Few studies have evaluated the efficacy of antiseizure medications (ASMs) according to the etiology of neonatal acute provoked seizures. We aimed to investigate the response to ASMs in term/near term neonates with acute arterial ischemic stroke (AIS), as well as the type of seizure at presentation and the monitoring approach.

Methods: We retrospectively evaluated neonates from 15 European level IV neonatal intensive care units who presented with seizures due to AIS and were monitored by continuous electroencephalography (cEEG) and/or amplitude-integrated EEG (aEEG) in whom actual recordings, timing, doses, and response to ASMs were available for review.

Results: One hundred seven neonates were referred, and 88 were included. Of those, 56 met the criteria for evaluating the treatment response. The mean time to treatment was 7.9 h (SD = 16.4), and the most frequently administered first-line ASM was phenobarbital (PB; 74/88, 84.1%). Seizures were controlled within 24 h from onset of symptoms in 64.3% (36/56) of neonates. Phenytoin (PHT) was effective in almost all neonates in whom it was trialed (24/25, 96.0%), whereas PB was effective in only 22.0% of patients (11/50). Infants treated with PB or PHT as first-line treatment (53/56, 94.6%) showed a higher response rate with PHT (6/6, 100.0%) than with PB (11/47, 23.4%). Monitoring approach and seizure types were evaluated in 88 infants. Forty-six of 88 (52.3%) were monitored with cEEG and 47.7% (42/88) with aEEG, with or without intermittent cEEG. The mean monitoring duration was 65.8 h (SD = 39.21). In 83 of 88 (94.3%) infants, the type of seizure suspected clinically prior to monitoring was confirmed afterward. Unilateral focal clonic seizures were seen in 71 of 88 infants (80.7%), whereas 11 of 88 (12.5%) presented with ictal apneas.

Significance: Our findings provide evidence in a large, homogenous cohort that PHT is more effective than PB in treating neonatal acute symptomatic seizures due to AIS.

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钠通道阻滞剂治疗动脉缺血性中风引起的新生儿惊厥的疗效。

目的：很少有研究根据新生儿急性诱发癫痫发作的病因评估抗癫痫药物（ASM）的疗效。我们旨在研究急性动脉缺血性卒中（AIS）的足月/近足月新生儿对抗癫痫药物的反应，以及发作类型和监测方法：我们回顾性评估了来自 15 个欧洲 IV 级新生儿重症监护病房的新生儿，这些新生儿因 AIS 而出现癫痫发作，并接受连续脑电图（cEEG）和/或振幅积分脑电图（aEEG）监测，其实际记录、时间、剂量和对 ASMs 的反应可供回顾：结果：共转诊了 107 名新生儿，纳入了 88 名。结果：共转诊了 107 名新生儿，纳入了 88 名，其中 56 名符合治疗反应评估标准。平均治疗时间为 7.9 小时（SD = 16.4），最常用的一线 ASM 是苯巴比妥（PB；74/88，84.1%）。64.3%的新生儿（36/56）在发病后24小时内控制住了癫痫发作。苯妥英（PHT）几乎对所有试用过的新生儿都有效（24/25，96.0%），而 PB 仅对 22.0% 的患者有效（11/50）。将 PB 或 PHT 作为一线治疗的婴儿（53/56，94.6%）显示，PHT 的反应率（6/6，100.0%）高于 PB（11/47，23.4%）。对 88 名婴儿的监测方法和癫痫发作类型进行了评估。88 名婴儿中有 46 名（52.3%）接受了 cEEG 监测，47.7%（42/88）接受了 aEEG 监测，包括或不包括间歇性 cEEG 监测。平均监测时间为 65.8 小时（SD = 39.21）。88 名婴儿中有 83 名（94.3%）在监测前临床上怀疑的癫痫发作类型在监测后得到了证实。88 名婴儿中有 71 名（80.7%）出现单侧局灶性阵挛发作，88 名婴儿中有 11 名（12.5%）出现发作性呼吸暂停：我们的研究结果在一个大型同质群组中提供了证据，证明 PHT 在治疗 AIS 引起的新生儿急性症状性癫痫发作方面比 PB 更有效。

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来源期刊

Epilepsia 医学-临床神经学

CiteScore

10.90

自引率

10.70%

发文量

319

审稿时长

2-4 weeks

期刊介绍： Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.