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Guidotti I, Lugli L, Ori L, Roversi MF, Casa Muttini ED, Bedetti L, Pugliese M, Cavalleri F, Stefanelli F, Ferrari F, Berardi A. Neonatal seizures treatment based on conventional multichannel EEG monitoring: an overview of therapeutic options. Expert Rev Neurother 2022; 22:623-638. [PMID: 35876114 DOI: 10.1080/14737175.2022.2105698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Seizures are the main neurological emergency during the neonatal period and are mostly acute and focal. The prognosis mainly depends on the underlying etiology. Conventional multichannel video-electroencephalographic (cEEG) monitoring is the gold standard for diagnosis, but treatment remains a challenge. AREAS COVERED : This review, based on PubMed search over the last 4 decades, focuses on the current treatment options for neonatal seizures based on cEEG monitoring. There is still no consensus on seizure therapy, owing to poor scientific evidence. Traditionally, the first-line treatments are phenobarbital and phenytoin, followed by midazolam and lidocaine, but their efficacy is limited. Therefore, current evidence strongly suggests the use of alternative antiseizure medications. Randomized controlled trials of new drugs are ongoing. EXPERT OPINION : Therapy for neonatal seizures should be prompt and tailored, based on semeiology, mirror of the underlying cause, and cEEG features. Further research should focus on antiseizure medications that directly act on the etiopathogenetic mechanism responsible for seizures and are therefore more effective in seizure control.
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Affiliation(s)
- Isotta Guidotti
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Licia Lugli
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Luca Ori
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Maria Federica Roversi
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Elisa Della Casa Muttini
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Luca Bedetti
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Marisa Pugliese
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Francesca Cavalleri
- Division of Neuroradiology, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, Modena, Italy
| | - Francesca Stefanelli
- Department of Medical and Surgical Sciences of the Mothers, Children and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Ferrari
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Alberto Berardi
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
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Aridas JD, Yawno T, Sutherland AE, Nitsos I, Wong FY, Hunt RW, Ditchfield M, Fahey MC, Malhotra A, Wallace EM, Gunn AJ, Jenkin G, Miller SL. Melatonin augments the neuroprotective effects of hypothermia in lambs following perinatal asphyxia. J Pineal Res 2021; 71:e12744. [PMID: 34032315 DOI: 10.1111/jpi.12744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
Therapeutic hypothermia (TH) is standard care in high-resource birth settings for infants with neonatal encephalopathy. TH is partially effective and adjuvant therapies are needed. Here, we examined whether the antioxidant melatonin (MLT) provides additive benefit with TH, compared to TH alone or MLT alone, to improve recovery from acute encephalopathy in newborn lambs. Immediately before cesarean section delivery, we induced asphyxia in fetal sheep via umbilical cord occlusion until mean arterial blood pressure fell from 55 ± 3 mm Hg in sham controls to 18-20 mm Hg (10.1 ± 1.5 minutes). Lambs were delivered and randomized to control, control + MLT (60 mg iv, from 30 minutes to 24 hours), asphyxia, asphyxia + TH (whole-body cooling to 35.1 ± 0.8°C vs. 38.3 ± 0.17°C in sham controls, from 4-28 hours), asphyxia + MLT, and asphyxia + TH + MLT. At 72 hours, magnetic resonance spectroscopy (MRS) was undertaken, and then brains were collected for neuropathology assessment. Asphyxia induced abnormal brain metabolism on MRS with increased Lactate:NAA (P = .003) and reduced NAA:Choline (P = .005), induced apoptotic and necrotic cell death across gray and white matter brain regions (P < .05), and increased neuroinflammation and oxidative stress (P < .05). TH and MLT were independently associated with region-specific reductions in oxidative stress, inflammation, and cell death, compared to asphyxia alone. There was an interaction between TH and MLT such that the NAA:Choline ratio was not significantly different after asphyxia + TH + MLT compared to sham controls but had a greater overall reduction in neuropathology than either treatment alone. This study demonstrates that, in newborn lambs, combined TH + MLT for neonatal encephalopathy provides significantly greater neuroprotection than either alone. These results will guide the development of further trials for neonatal encephalopathy.
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Affiliation(s)
- James Ds Aridas
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
| | - Tamara Yawno
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Amy E Sutherland
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
| | - Ilias Nitsos
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Flora Y Wong
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
| | - Rod W Hunt
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
- Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | | | - Michael C Fahey
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
| | - Atul Malhotra
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
| | - Euan M Wallace
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Alistair J Gunn
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Graham Jenkin
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Suzanne L Miller
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
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