Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Reducing the percentage of surviving infants with acute symptomatic seizures discharged on anti-seizure medication

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To evaluate the impact of inclusion of an anti-seizure medication (ASM) weaning protocol in a neonatal seizure pathway on the percent of infants discharged on ASMs.

Study design

This cohort study included surviving infants with acute symptomatic seizures treated with ASMs across three institutions. We evaluated infants in 2 epochs, pre- and post-implementation of the ASM weaning protocol. The primary outcome was discharge on ASM.

Results

Of 116 included infants, the percent of infants discharged on ASMs was 69% in epoch 1 versus 34% in epoch 2 (p < 0.001). There was no significant difference between epochs in recurrence of seizures after discharge by 1 year of age (p = 0.125). There was an annual decrease in the percent of infants discharged on ASM across all institutions.

Conclusion

Inclusion of a formal ASM weaning protocol as part of an institutional seizure pathway reduced percent of infants with acute symptomatic seizures discharged on ASM.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kharoshankaya L, Stevenson NJ, Livingstone V, Murray DM, Murphy BP, Ahearne CE, et al. Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy. Dev Med Child Neurol. 2016;58:1242–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neurodevelopmental outcome. Neurology. 2000;55:506–13.

    Article  CAS  PubMed  Google Scholar 

  3. Pressler RM, Abend NS, Auvin S, Boylan G, Brigo F, Cilio MR, et al. Treatment of seizures in the neonate: guidelines and consensus‐based recommendations—Special report from the ILAE Task Force on Neonatal Seizures. Epilepsia. 2023;64:2550–70.

    Article  CAS  PubMed  Google Scholar 

  4. Bittigau P, Sifringer M, Genz K, Reith E, Pospischil D, Govindarajalu S, et al. Antiepileptic drugs and apoptotic neurodegeneration in the developing brain. Proc Natl Acad Sci USA. 2002;99:15089–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Forcelli PA, Kim J, Kondratyev A, Gale K. Pattern of antiepileptic drug-induced cell death in limbic regions of the neonatal rat brain. Epilepsia. 2011;52:e207–e11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kaushal S, Tamer Z, Opoku F, Forcelli PA. Anticonvulsant drug-induced cell death in the developing white matter of the rodent brain. Epilepsia. 2016;57:727–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Farwell JR, Lee YJ, Hirtz DG, Sulzbacher SI, Ellenberg JH, Nelson KB. Phenobarbital for febrile seizures–effects on intelligence and on seizure recurrence. N. Engl J Med. 1990;322:364–9.

    Article  CAS  PubMed  Google Scholar 

  8. Sulzbacher S, Farwell JR, Temkin N, Lu AS, Hirtz DG. Late cognitive effects of early treatment with phenobarbital. Clin Pediatr. 1999;38:387–94.

    Article  CAS  Google Scholar 

  9. Maitre NL, Smolinsky C, Slaughter JC, Stark AR. Adverse neurodevelopmental outcomes after exposure to phenobarbital and levetiracetam for the treatment of neonatal seizures. J Perinatol. 2013;33:841–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sewell EK, Shankaran S, McDonald SA, Hamrick S, Wusthoff CJ, Adams-Chapman I, et al. Antiseizure medication at discharge in infants with hypoxic-ischaemic encephalopathy: an observational study. Arch Dis Child Fetal Neonatal Ed. 2023;108:421–8.

    Article  PubMed  Google Scholar 

  11. Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord. 2015;17:117–23.

    Article  PubMed  Google Scholar 

  12. Shellhaas RA, Wusthoff CJ, Numis AL, Chu CJ, Massey SL, Abend NS, et al. Early‐life epilepsy after acute symptomatic neonatal seizures: a prospective multicenter study. Epilepsia. 2021;62:1871–82.

    Article  CAS  PubMed  Google Scholar 

  13. Pisani F, Facini C, Pavlidis E, Spagnoli C, Boylan G. Epilepsy after neonatal seizures: literature review. Eur J Paediatr Neurol. 2015;19:6–14.

    Article  PubMed  Google Scholar 

  14. Glass HC, Soul JS, Chang T, Wusthoff CJ, Chu CJ, Massey SL, et al. Safety of early discontinuation of antiseizure medication after acute symptomatic neonatal seizures. JAMA Neurol. 2021;78:817–25.

    Article  PubMed  Google Scholar 

  15. WHO Guidelines Approved by the Guidelines Review Committee. Guidelines on neonatal seizures. Geneva: World Health Organization, 2011.

  16. Shellhaas RA, Chang T, Wusthoff CJ, Soul JS, Massey SL, Chu CJ, et al. Treatment duration after acute symptomatic seizures in neonates: a multicenter cohort study. J Pediatr. 2017;181:298–301. e1.

    Article  PubMed  Google Scholar 

  17. Shellhaas RA, Chang T, Wusthoff CJ, Soul JS, Massey SL, Chu CJ, et al. Treatment duration after acute symptomatic seizures in neonates: a multicenter cohort study. J Pediatr. 2017;181:298–301.e1.

    Article  PubMed  Google Scholar 

  18. Dizon MLV, Rao R, Hamrick SE, Zaniletti I, DiGeronimo R, Natarajan G, et al. Practice variation in anti-epileptic drug use for neonatal hypoxic-ischemic encephalopathy among regional NICUs. BMC Pediatr. 2019;19:67.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bashir RA, Espinoza L, Vayalthrikkovil S, Buchhalter J, Irvine L, Bello-Espinosa L, et al. Implementation of a neurocritical care program: improved seizure detection and decreased antiseizure medication at discharge in neonates with hypoxic-ischemic encephalopathy. Pediatr Neurol. 2016;64:38–43.

    Article  PubMed  Google Scholar 

  20. Wietstock SO, Bonifacio SL, McCulloch CE, Kuzniewicz MW, Glass HC. Neonatal neurocritical care service is associated with decreased administration of seizure medication. J Child Neurol. 2015;30:1135–41.

    Article  PubMed  Google Scholar 

  21. Boylan G, Burgoyne L, Moore C, O’Flaherty B, Rennie J. An international survey of EEG use in the neonatal intensive care unit. Acta Paediatr. 2010;99:1150–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics – Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Anne Marie Nangle, Alyssa Carlson, Shannon Hamrick, Anthony Piazza, Allison Vale & Elizabeth K. Sewell

  2. Pediatric Biostatistics Core, Department of Pediatrics – Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Zhulin He

  3. Division of Pediatric Neurology, Department of Pediatrics – Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Sonam Bhalla & Monideep Dutt

  4. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Jessica Bullock & Passion Jones

  5. Emory University School of Nursing, Atlanta, GA, USA

    Alyssa Carlson

Authors
  1. Anne Marie Nangle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhulin He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonam Bhalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jessica Bullock
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alyssa Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Monideep Dutt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shannon Hamrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Passion Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Anthony Piazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Allison Vale
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Elizabeth K. Sewell
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AMN contributed to the data curation, investigation, and writing of the original manuscript. ZH contributed to the formal analysis and critical review of the final manuscript. EKS contributed to the conceptualization, data curation, investigation, methodology, and drafting of the original manuscript. MD, SB, SH, AP, AC, AV, JB, and PJ contributed to the investigation and critical review of the final manuscript.

Corresponding author

Correspondence to Elizabeth K. Sewell.

Ethics declarations

Competing interests

EKS has received consultant fees from Hospicom and Sun Pharmaceutical Industries, Inc. The remaining authors have no conflicts of interest to disclose directly related to this study.

Ethics approval and consent to participate

The Emory University Institutional Review Board approved this study with waiver of consent (STUDY00005996). This research involving human subjects, human material, or human data is in accordance with the Declaration of Helsinki.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nangle, A.M., He, Z., Bhalla, S. et al. Reducing the percentage of surviving infants with acute symptomatic seizures discharged on anti-seizure medication. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02044-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41372-024-02044-9

Search

Advanced search

Quick links