ASM use may be stopped right after resolution of acute provoked neonatal seizures

In neonates with acute provoked seizures, continued use of antiseizure medications (ASMs) even after resolution of seizures may be unnecessary, as shown in a prospective, comparative effectiveness study.

Researchers enrolled neonates with acute provoked seizures at nine US Neonatal Seizure Registry centres with level IV neonatal intensive care units and level IV paediatric epilepsy programs. ASM treatment duration was quantified as follows: (1) discontinuation before discharge from the neonatal seizure admission or (2) maintenance at the time of hospital discharge.

The primary outcome was cognition, evaluated using the Wechsler Preschool and Primary Scale of Intelligence at age 5–6 years. Secondary outcomes included functional development (Vineland Adaptive Behavior Scale, 3rd Edition, assessed at 3–8 years) and postneonatal epilepsy (assessed at 1–8 years).

A total of 284 children with at least one follow-up were included in the analyses. ASMs were maintained upon discharge from the neonatal seizure admission in more than half of these children (63 percent), for a median duration of 4.2 months. On the other hand, ASMs were discontinued prior to hospital discharge in 37 percent, for a median treatment duration of 6 days. Among newborns maintained on ASMs, 85 percent received phenobarbital either as monotherapy or as part of polytherapy.

Children in the discontinued vs maintained ASM groups showed similar full-scale IQ at age 5 years (adjusted difference, 10 points), functional development at ages 3–8 years (adjusted difference, 0 points), and postneonatal epilepsy risk at ages 1–8 years (adjusted hazard ratio, 0.93, 95 percent confidence interval, 0.48–1.80).

These findings suggest that prolonged administration of ASM for several months after resolution of acute provoked neonatal seizures may only expose infants to unnecessary medications and support the safety of discontinuing ASM right after seizure resolution.