Ahrens Stephanie, Ream Margie A, Slaughter Laurel A
Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, 611 E Livingston Avenue FB4, Columbus, OH, 43205, USA.
Curr Treat Options Neurol. 2019 Feb 18;21(2):8. doi: 10.1007/s11940-019-0546-5.
The purpose of this review is to report recent advances in treatment of neonatal seizures, with a specific focus on new literature since a 2013 systematic review performed by this author (Slaughter) and others. There is a paucity of data with regard to well-defined status epilepticus (SE) in neonates, so treatment of recurrent seizures was also included in this inquiry. We aimed to summarize the efficacy and safety profiles of current therapeutic options as well as describe trends in medication selection in the neonatal intensive care unit (NICU) setting.
Phenobarbital remains first-line therapy in practice, though there is increasing evidence of its neurotoxicity and long-term sequelae. Bumetanide failed an open-label trial for efficacy, demonstrated an increased risk for hearing loss, and has since fallen out of favor for use in this population. New agents, such as levetiracetam and topiramate, still have very limited data but appear to be as efficacious as older medications, with more favorable side effect profiles. There are limited high-level evidence-based data to guide treatment of neonatal seizures. Emerging research focusing on drug mechanisms and safety profiles may provide additional information to guide decisions; however, further research is needed.
本综述旨在报告新生儿惊厥治疗的最新进展，特别关注自作者（斯劳特）及其他人在2013年进行系统综述以来的新文献。关于新生儿明确的癫痫持续状态（SE）的数据匮乏，因此本次研究也纳入了复发性惊厥的治疗。我们旨在总结当前治疗选择的疗效和安全性概况，并描述新生儿重症监护病房（NICU）环境下药物选择的趋势。
在实际应用中，苯巴比妥仍然是一线治疗药物，尽管越来越多的证据表明其具有神经毒性和长期后遗症。布美他尼的开放标签试验未证明其疗效，且显示听力丧失风险增加，此后已不再受该人群青睐。新型药物，如左乙拉西坦和托吡酯，数据仍然非常有限，但似乎与旧药物一样有效，且副作用更小。指导新生儿惊厥治疗的高水平循证数据有限。专注于药物机制和安全性概况的新兴研究可能会提供更多信息以指导决策；然而，仍需要进一步研究。
