Seizure Pharm Flashcards
What are the most common causes of neonatal seizures?
HIE, stroke, intracranial hemorrhage, metabolic derangements, infection
What features of the immature neonatal brain increase the risk for seizure activity?
High synaptic and dendritic spine density, overexpression of glutamate receptors, hyperexcitable state
What is HIE and how can it lead to seizures?
HIE is hypoxic-ischemic encephalopathy, resulting from birth asphyxia or prolonged hypoxemia, reducing cerebral blood flow
What laboratory diagnostics should be sent when seizures are suspected in neonates?
- CBCD
- Coag panel
- Blood and spinal fluid cultures
- CSF testing for glucose, protein, cell counts, HSV
- Liver function tests and creatinine if asphyxia is suspected
What imaging is recommended for identifying hydrocephalus or large lesions in neonates with seizures?
HUS (Head Ultrasound)
Why is EEG important in diagnosing neonatal seizures?
Many seizures do not have observable clinical manifestations, and EEGs provide a reliable diagnosis
What are the primary goals in managing neonatal seizures?
- Identify cause
- Control seizures
- Prevent further injury
- Maintain normothermia and normal physiological parameters
What is the drug of choice for treating neonatal seizures?
Phenobarbital
What is the mechanism of action of phenytoin?
Inhibits repetitive neuronal firing by blocking voltage-sensitive sodium channels
What are the risks associated with phenytoin use?
- High risk of toxicity
- Non-linear kinetics
- Adverse drug reactions
What is the mechanism of action of phenobarbital?
Potentiates inhibitory neurotransmission by prolonging the open state of GABA-mediated sodium channels
What are the common types of neonatal seizures?
- Acute symptomatic seizures
- General/genetic epilepsies
- Clonic seizures
- Tonic seizures
What is a critical factor in the timing of treatment for neonatal seizures?
The earlier seizure medication is given, the better control is likely achieved
What can excessive neuronal excitation during seizures lead to?
Accelerated neuronal death via necrosis, apoptosis, necroptosis, ferroptosis, and autosis
What is the significance of seizure burden in neonatal seizures?
Prolonged seizures can independently worsen brain injury, especially in an acutely injured brain
What are behavioral states in neonates that may indicate seizure activity?
- Awake: eyes open
- Asleep: eyes closed
- Lethargy: brief eye opening after stimulation
- Coma: no eye opening after stimulation
What is the role of cooling in the context of neonatal seizures?
Cooling decreases neuronal excitability, reduces cerebral necrosis and apoptosis, and downregulates inflammation
What are the pharmacokinetic characteristics of neonates that affect medication dosing?
- Slow and erratic PO absorption
- Delayed gastric emptying
- Low hepatic metabolism
What is the effect of medications like phenobarbital on aEEG?
Medications may depress EEG background, potentially flattening it
What is the risk of seizures in neonates with HIE?
Seizures in the context of HIE will improve over time
What are the treatment options for neonatal metabolic epilepsies?
Carbamazepine may be used to rule in/rule out potassium channelopathy
What is the typical onset timing for seizures in neonates?
Seizures typically start within the first 72 hours and resolve in a few days
What is the risk associated with overtreatment of neonatal seizures?
Neurotoxicity and prolonged NICU stay
What is the risk associated with undertreatment of neonatal seizures?
Kindling of additional seizures and worsened brain injury
