Anticonvulsant Therapy After Neonatal Seizures—How Long Should it Be Continued?

The risk of epilepsy or afebrile seizures after convulsions in the neonatal period is compared with the benefits and risks of chronic use of anticonvulsants in infants. The best predictor of later seizures appears to be the presence of moderate to severe neurologic damage. In the absence of such deficits, the risk is below 10%, but increases to 50-70% when damage is severe. A comparison of reports indicates no difference in seizure recurrence rates when anticonvulsants are stopped early in the neonatal period or when treatment is longer, even in the high-risk group. After phenobarbital is discontinued and the plasma concentration falls below the therapeutic range, seizures usually recur within a few days or not for several months. Only 50% of these seizure types are expected to be controlled with phenobarbital. Long-term phenobarbital use is associated with impaired cognitive function in infants and toddlers, and retarded brain growth in rodent studies.