Neonatal seizures

In the treatment of neonatal seizures, the chasm between what we know from the bench and what we do in routine bedside practice is wide. The two most commonly used medications, phenobarbital and phenytoin, were introduced as anticonvulsants in 1914 and 1938. Little was known then about the control of cellular and network excitability or how the developing brain is physiologically distinct from the mature brain. Phenobarbital and phenytoin had been used to treat seizures in the adult human, and were handed down for use in infants and children. Can we attribute the endurance of these remedies to their impressive efficacy? Unfortunately not. An earlier study1 demonstrated that fewer than 50% of the infants treated with either of those medications responded with electrographic cessation of seizures. The choice of phenobarbital or phenytoin likely rests on the availability of those agents in parenteral dosage forms for premature infants who are on gut …