Short-Term Effects of Phenobarbitone on Electrographic Seizures in Neonates.

Abstract

BACKGROUND:

Phenobarbitone is the most common first-line anti-seizure drug and is effective in approximately 50% of all neonatal seizures.

OBJECTIVE:

To describe the response of electrographic seizures to the administration of intravenous phenobarbitone in neonates using seizure burden analysis techniques.

METHODS:

Multi-channel conventional EEG, reviewed by experts, was used to determine the electrographic seizure burden in hourly epochs. The maximum seizure burden evaluated 1 h before each phenobarbitone dose (T-1) was compared to seizure burden in periods of increasing duration after each phenobarbitone dose had been administered (T+1, T+2 to seizure offset). Differences were analysed using linear mixed models and summarized as means and 95% CI.

RESULTS:

Nineteen neonates had electrographic seizures and met the inclusion criteria for the study. Thirty-one doses were studied. The maximum seizure burden was significantly reduced 1 h after the administration of phenobarbitone (T+1) [-14.0 min/h (95% CI: -19.6, -8.5); p < 0.001]. The percentage reduction was 74% (IQR: 36-100). This reduction was temporary and not significant within 4 h of administrating phenobarbitone. Subgroup analysis showed that only phenobarbitone doses at 20 mg/kg resulted in a significant reduction in the maximum seizure burden from T-1 to T+1 (p = 0.002).

CONCLUSIONS:

Phenobarbitone significantly reduced seizures within 1 h of administration as assessed with continuous multi-channel EEG monitoring in neonates. The reduction was not permanent and seizures were likely to return within 4 h of treatment.

• Authors: Evonne Low, Nathan J Stevenson, Sean R Mathieson, Vicki Livingstone, Anthony C Ryan, Janet M Rennie, Geraldine B Boylan
• Journal: Neonatology (Neonatology) Vol. 110 Issue 1 Pg. 40-6 ( 2016) ISSN: 1661-7819 [Electronic] Switzerland
• PMID: 27027306 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2016 S. Karger AG, Basel.

Chemical References

• Anticonvulsants
• Phenobarbital

Topics

• Anticonvulsants (administration & dosage)
• Electroencephalography
• Humans
• Infant, Newborn
• Infant, Newborn, Diseases (drug therapy)
• Monitoring, Physiologic
• Phenobarbital (administration & dosage)
• Seizures (drug therapy)
• Time Factors