ABSTRACT
The International League Against Epilepsy (ILAE) task force on neonatal seizures has recently published draft guidelines and consensusbased recommendations on the treatment of neonatal seizures. This update provides a summary of the recommendations and the changes in management compared to the previous WHO ILAE guidelines, published in 2011, with emphasis on practical decision making requirements for a pediatrician.
ABSTRACT
Background: Febrile seizures are a common, yet benign neurological disorder and characterized by convulsions associated with fever in childhood due to the effect of fever ontheimmature brain. All treating clinicians must understand the nature and evaluation of this benign condition.Objective:To provide up-to-date knowledge on febrile seizures and their evaluation.Methods:A search was conducted with key terms “febrile seizures” or “febrile convulsion” invarious databases and writings. The literature included clinical trials, descriptive and observational studies, meta-analyses, and randomized control trials. Results:Febrile seizures occur between the ages of6 months to 5years in all ethnic groups. The exact mechanism has been still unknown although several etiologies have been proposed including genetic and environmental factors. Febrile seizures can be either simple or complex. Febrile seizures generally occur within the first day of feverbut rarely happen after 24 hours. Most of the time, febrile convulsions are short-lasting and self-limiting. The diagnosis is mainly based on the clinical description,and investigations have a limited role. Children less than one yearof age with suspicion of bacterialinfection need lumbar puncture to exclude meningitis. Management mostly depends on control of fever and the treatment of underlying conditions which precipitate fever. Some children can have prolonged convulsions which need anticonvulsants to abort an acute attack. Otherwise,long term prophylactic anticonvulsants have an insignificant role in the prevention of recurrencesof febrile seizures. Physical methods also play an insignificant role. As the condition commonly carries a favorable prognosis, unnecessary interventions should be avoided. Since febrile seizures recur in a significant proportion of children, they may bring needless fears and anxieties in parents. However, proper health education for parents by health care personnel might alleviate the anxiety and improve the quality of life of children with febrile seizures.Conclusion:Febrile convulsions are benign and self-limiting. Continuous use of anticonvulsants to prevent the recurrence of febrile seizures is notendorsed. Intermittent prophylaxis at the time of fever is also not routinely recommended. Both physical methods and antipyretics have limited value in the prevention of febrile seizures
ABSTRACT
Background: There is increasing evidence that neonatal seizures have an adverse effect on neurodevelopmental progression and it may predispose to cognitive, behavioral or epileptic complications later in life. The objective of this study was to compare the efficacy of phenobarbitone and levetiracetam for the treatment of neonatal seizures in term and late preterm neonates. The study was aimed to know the efficacy of phenobarbitone (PB) in comparison with levetiracetam (LEV) in controlling neonatal seizures.Methods: This was a randomized controlled trial where data of the babies with seizures weighing more than 2 kg who were admitted in NICU of Muzaffarnagar Medical College was collected and analysed for intervention to either phenobarbitone or levetiracetam.Results: Clinically apparent seizures were controlled in only 65.38% neonates assigned to receive levetiracetam as compared to 76.92% neonates assigned to receive phenobarbitone.Conclusions: LEV although lesser effective than PB with very fewer side effects is found to be a good alternative in controlling neonatal seizures.
ABSTRACT
Background: Neonatal seizure management has not changed much in the last 50 years. Neuronal apoptosis in animal models and cognitive impairment in human subjects has been reported with the use of Phenobarbitone. Levetiracetam is advantageous as it is effective, well tolerated and has least drug interactions.Methods: This double blinded, randomized, parallel group, active controlled study was conducted among 66 neonates in the Neonatal intensive care unit of a tertiary care hospital for a period of 18 months. Neonates with seizures fulfilling the inclusion criteria were treated either with Phenobarbitone or Levetiracetam. Seizure control was defined as no seizure activity within 40 minutes of the administration of the first drug. Failure of first line agent was treated with Phenytoin. Neonates were observed for a period of 14 weeks for recurrence of seizure and any serious adverse effects.Results: Effective seizure control was achieved in 64.7% neonates in Levetiracetam group as compared to 31.2% in Phenobarbitone group (p <0.05). Early resumption of breast feeds within 6 hours of therapy was achieved in 73.5% neonates treated with Levetiracetam compared to 31.2% neonates treated with Phenobarbitone (p value = 0.001).Conclusions: Levetiracetam is a promising alternative as first line Anti-epileptic drug in neonates with seizures. Prolonged sedation was the adverse effect noted to Phenobarbitone that made breast feeding and neuro- assessment difficult. No serious adverse effects were seen with Levetiracetam.
ABSTRACT
Background: Seizures are the most common indicator of significant neurologic dysfunction in neonatal period with incidence of 11.7/1000 live births. Phenobarbitone is used as first line of treatment since 1900s. Newer anti-epileptic drugs (AED) available are Levetiracetam, Topiramate etc. Present study focused on utilization pattern of AED, treatment outcomes and to study economic burden of disease.Methods: An observational study was done on 100 neonates admitted to Neonatal Intensive Care Unit in Basaveshwara hospital, Kalaburagi (June 2016-May 2017). Prescription data was entered into specially designed proforma, WHO core indicators were determined. The data was analyzed using descriptive statistics and presented as means and percentages.Results: Majority of neonates were male (58%) and 63% were diagnosed with subtle seizure. Out of 458 drugs prescribed, 201 were antiepileptics. 41% cases were successfully managed by monotherapy. Most commonly used drug was phenobarbitone (82%) and phenytoin (31%). Leviteracetam, newer AED was used in 3 refractory cases. The major combination of drugs used was Phenobarbitone-Phenytoin (24%). AED were rationally prescribed, but antibiotic was over-utilized(68%). 31% cases had adverse drug reaction. On average per prescription, number of drugs used were 4.6 and drug cost was Rs.3803/-. The total cost of illness per patient was Rs.16363/-.Conclusions: AED utilization in neonatal seizures was in accordance to guidelines, with phenobarbitone being extensively used despite its potential neurotoxicity. The utilization of newer AED would increase if clinicians are supported with the safety and efficacy data. Although monotherapy was preferred with respect to AED, antibiotics were highly prescribed; hence awareness is needed to curb this practice.
ABSTRACT
Stevens-Johnson Syndrome (SJS) is a life-threatening acute hypersensitive reaction affecting the skin and mucous membranes. We report a case with SJS likely induced by phenobarbitone during the switch of sodium valproate and phenobarbitone regimen. The patient reported fever with fluid-filled lesions all over the body and redness and burning sensation of both the eyes. Peeling of the skin due to rupture of the fluid-filled lesions and pigmentation on the skin for 10 days. Based on a physical examination and laboratory findings, he was diagnosed with Phenobarbital induced Stevens-Johnson syndrome. The patient was administered systemic steroid therapy and treated symptomatically and finally replaced with phenobarbitone and sodium valproate. During the hospital stay, the patient appeared normal and the skin lesions disappeared, after two weeks of treatment.
ABSTRACT
Objective: To compare the efficacy of phenobarbitone and phenytoin for treatment of neonatal seizures in term and nearterm neonates. Design: Open labeled randomized controlled trial. Setting: Neonatal intensive care unit of a level II unit from India, from November 2008 to September 2009. Participants: All term and late pre-term neonates admitted with clinically apparent seizures and not having any transient metabolic disorders (hypoglycemia or hypocalcemia) were randomly assigned. Intervention: Phenobarbitone (n=54) or phenytoin (n=55) intravenously 20 mg/kg/dose over 20-30 min. Neonates whose seizures were not controlled by the assigned drug were then crossed over to be treated with other drug in same dose. Primary outcome variable: Clinical control of seizures (seizure free period of 24 hours after giving anticonvulsant). Results: Baseline characteristics including mean birthweight, gestation age and sex were comparable in both groups. Seizures were controlled in 8 of the 55 (14.5%) neonates who received phenytoin, as compared to 39 of 54 (72.2%) neonates who received phenobarbitone (P <0.001). In babies not responding to assigned drugs, after cross-over to the other drug, seizure control was achieved in 44/55 (80%) of the neonates assigned to receive phenytoin first as compared to 49/54 (91%) of those assigned to receive phenobarbitone first (P=0.014). After maximum dose of phenobarbitone seizures were controlled in 49/55(89%) in phenytoin group and 52/54 (96%) in phenobarbitone group (P<0.05). Conclusion: Phenobarbitone is more efficacious than phenytoin in control of clinical seizures in term or near-term neonates, irrespective of etiology.
ABSTRACT
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a life threatening cutaneous drug reaction with visceral involvement and hematological abnormalities. Being a rare side effect, it is often under-reported and misdiagnosed. The fatal adverse drug reaction is associated most commonly with aromatic anti-epileptics phenytoin, carbamazepine and less frequently with phenobarbitone. Here, we report a case of phenobarbitone induced DRESS in a 1 year old male child. He succumbed to fulminant hepatic failure inspite of being put on steroids, hepatoprotectives, antibiotics and ventilatory support.
ABSTRACT
The methanolic extract of M. longifolia (MLME) and a compound a triterpene, derivative of madhucic acid (dMA) isolated from the leaves of M. longifolia, were investigated for their possible neuropharmacological activities in mice using phenobarbitone induced sleeping time, spontaneous motor activity, marble burying test and Eddy’s hot plate method. LD50 for MLME and dMA were 100 and 10 mg/kg of body weight, respectively. Both MLME and dMA (10 mg/kg and 2 mg/kg oral route respectively) exhibited significant increase in phenobarbitone induced sleeping time, greater reduction in spontaneous motor activity and marble burying activity, confirming their sedative nature. Both MLME and dMA also exhibited considerable antinociceptive activity in experimental animals. The results suggest that both MLME and dMA have CNS depressant activity in mice.
ABSTRACT
Objective: To evaluate the role of phenobarbitone in the management of unconjugated hyperbilirubinemia during first two weeks of life in preterm neonates. Design: Meta-analysis. Methods: A study was eligible for inclusion in the metaanalysis if it randomized preterm neonates into control and treatment groups. Standard search strategy of the Cochrane Neonatal Review Group was used. For categorical and continuous data the odds ratio (OR) and weighted mean difference (WMD) were calculated, respectively. 95% confidence intervals were used and a fixed effects model was assumed for the meta-analysis. Main outcome measures: Peak serum bilirubin, duration of phototherapy, need of phototherapy and exchange transfusion, neurodevelopmental outcome and adverse effects. Results: A total of 19 potentially relevant studies were identified. Of these, 3 studies (497 neonates) were included in the meta-analysis. Peak serum bilirubin was significantly lower in phenobarbitone group (mean difference: –1.78 mg/dL, 95% CI: –2.29 to –1.27). Duration of phototherapy was shorter (mean difference: –14.75 h, 95% CI: –26.67 to –2.83). Need of phototherapy (OR: 0.33, 95% CI: 0.13 to 0.81) and exchange transfusion (OR: 0.30, 95% CI: 0.14 to 0.64) were also reduced in phenobarbitone group. Conclusion: Phenobarbitone reduces peak serum bilirubin, duration and need of phototherapy and need of exchange transfusion in preterm very low birthweight neonates. Further studies are warranted to evaluate adverse effects and neurodevelopmental outcome.