Child Neuropsychiatry Unit, University of Parma, Parma, Italy.
Child Neuropsychiatry Unit, University of Parma, Parma, Italy.
Semin Fetal Neonatal Med. 2018 Jun;23(3):191-196. doi: 10.1016/j.siny.2017.12.003. Epub 2017 Dec 15.
Acute symptomatic neonatal seizures in preterm newborns are a relevant clinical challenge due to the presence of many knowledge gaps. Etiology-wise, acute symptomatic seizures have an age-specific epidemiology, with intraventricular hemorrhage and its complications representing the first cause in extremely and very preterm neonates, whereas other etiologies have similar occurrence rates as in full-term infants. Specific treatment strategies for the premature neonates are not yet available. Studies suggest a similarly low response rate with even more unfavorable prognosis than in full-term infants. Pharmacodynamic and pharmacokinetic changes are likely under way during the preterm period, with the potential to affect both effectiveness and safety of antiepileptic drugs in these patients. However, due to the lack of clear evidence to guide prioritization of second-line drugs, off-label medications are frequently indicated by review papers and flow-charts, and are prescribed in clinical practice. We therefore conclude by exploring potential future lines of research.
早产儿急性症状性癫痫发作是一个具有挑战性的临床问题，因为目前仍有许多知识空白。从病因学角度来看，急性症状性癫痫发作具有特定年龄的流行病学特征，脑室出血及其并发症是极早产儿和超早产儿的首要病因，而其他病因的发生率与足月儿相似。早产儿目前尚无特定的治疗策略。研究表明，其反应率同样较低，预后甚至比足月儿更差。在早产儿时期，药物动力学和药效学可能发生变化，这可能会影响这些患者的抗癫痫药物的有效性和安全性。然而，由于缺乏明确的证据来指导二线药物的优先排序，综述文章和流程图经常指出超适应证药物，并在临床实践中开这些药物。因此，我们通过探讨潜在的未来研究方向来得出结论。
