Influence of etiology on treatment choices for neonatal seizures: A survey among pediatric neurologists

Robertino Dilena, Paola De Liso, Matteo Di Capua, Dario Consonni, Giuseppe Capovilla, Francesco Pisani, Agnese Suppiej, Giovanna Vitaliti, Raffaele Falsaperla, Dario Pruna

Research output: Contribution to journalArticle

Abstract

Background: A targeted treatment approach is increasingly promoted in epilepsy management. Aim: To investigate if etiology (both established or initially presumed) influences antiepileptic drug choice of experts in neonatal seizures. Methods: An invitation to participate to a web-based questionnaire was sent to Italian pediatric neurologists affiliated to the Italian Society of Pediatric Neurology (SINP). Results: 19 pediatric neurologists from different centers, all consultants of third level Neonatal Intensive Care Units (NICUs) answered. As first-line drug phenobarbital was the most common choice, it was used in 79% of cases of acute symptomatic seizures, in 63% of structural epilepsy, in 42% of genetic epilepsies. As second-line drug phenytoin was used by 58% in acute symptomatic seizures, 37% in structural epilepsy, 5% in genetic epilepsy. Pyridoxine/pyridoxalphosphate was much more used in genetic epilepsy (as first-line in 26%, as second-line in 37%) than in the other two conditions. Long-term conventional EEG monitoring was suggested as important to verify efficacy of drugs in controlling seizures by 84% of interviewed neurologists, but EEG was available around the clock in only 53% of their centers. 1 to 3-channel aEEG/EEG (commonly named CFM) was often used instead of conventional EEG monitoring. Conclusion: This is the first survey looking at a targeted approach in treatment of neonatal seizures by pediatric neurologists consulted by NICUs. The treatment approach is similar to previous surveys in case of acute symptomatic seizures, but in case of other etiologies the choices are different, especially for the second-line option. Larger studies should address this topic.

Original languageEnglish
Pages (from-to)595-599
JournalBrain and Development
Volume41
Issue number7
DOIs
Publication statusPublished - Jan 1 2019

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Epilepsy
Seizures
Pediatrics
Electroencephalography
Neonatal Intensive Care Units
Therapeutics
Pharmaceutical Preparations
Pyridoxine
Phenytoin
Phenobarbital
Neurology
Consultants
Anticonvulsants
Neurologists
Surveys and Questionnaires

Keywords

  • aEEG
  • Antiepileptic drugs
  • EEG
  • Neonatal seizures
  • Survey
  • Targeted therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Influence of etiology on treatment choices for neonatal seizures : A survey among pediatric neurologists. / Dilena, Robertino; De Liso, Paola; Di Capua, Matteo; Consonni, Dario; Capovilla, Giuseppe; Pisani, Francesco; Suppiej, Agnese; Vitaliti, Giovanna; Falsaperla, Raffaele; Pruna, Dario.

In: Brain and Development, Vol. 41, No. 7, 01.01.2019, p. 595-599.

Research output: Contribution to journalArticle

Dilena, Robertino ; De Liso, Paola ; Di Capua, Matteo ; Consonni, Dario ; Capovilla, Giuseppe ; Pisani, Francesco ; Suppiej, Agnese ; Vitaliti, Giovanna ; Falsaperla, Raffaele ; Pruna, Dario. / Influence of etiology on treatment choices for neonatal seizures : A survey among pediatric neurologists. In: Brain and Development. 2019 ; Vol. 41, No. 7. pp. 595-599.
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abstract = "Background: A targeted treatment approach is increasingly promoted in epilepsy management. Aim: To investigate if etiology (both established or initially presumed) influences antiepileptic drug choice of experts in neonatal seizures. Methods: An invitation to participate to a web-based questionnaire was sent to Italian pediatric neurologists affiliated to the Italian Society of Pediatric Neurology (SINP). Results: 19 pediatric neurologists from different centers, all consultants of third level Neonatal Intensive Care Units (NICUs) answered. As first-line drug phenobarbital was the most common choice, it was used in 79{\%} of cases of acute symptomatic seizures, in 63{\%} of structural epilepsy, in 42{\%} of genetic epilepsies. As second-line drug phenytoin was used by 58{\%} in acute symptomatic seizures, 37{\%} in structural epilepsy, 5{\%} in genetic epilepsy. Pyridoxine/pyridoxalphosphate was much more used in genetic epilepsy (as first-line in 26{\%}, as second-line in 37{\%}) than in the other two conditions. Long-term conventional EEG monitoring was suggested as important to verify efficacy of drugs in controlling seizures by 84{\%} of interviewed neurologists, but EEG was available around the clock in only 53{\%} of their centers. 1 to 3-channel aEEG/EEG (commonly named CFM) was often used instead of conventional EEG monitoring. Conclusion: This is the first survey looking at a targeted approach in treatment of neonatal seizures by pediatric neurologists consulted by NICUs. The treatment approach is similar to previous surveys in case of acute symptomatic seizures, but in case of other etiologies the choices are different, especially for the second-line option. Larger studies should address this topic.",
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AU - Capovilla, Giuseppe

AU - Pisani, Francesco

AU - Suppiej, Agnese

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AB - Background: A targeted treatment approach is increasingly promoted in epilepsy management. Aim: To investigate if etiology (both established or initially presumed) influences antiepileptic drug choice of experts in neonatal seizures. Methods: An invitation to participate to a web-based questionnaire was sent to Italian pediatric neurologists affiliated to the Italian Society of Pediatric Neurology (SINP). Results: 19 pediatric neurologists from different centers, all consultants of third level Neonatal Intensive Care Units (NICUs) answered. As first-line drug phenobarbital was the most common choice, it was used in 79% of cases of acute symptomatic seizures, in 63% of structural epilepsy, in 42% of genetic epilepsies. As second-line drug phenytoin was used by 58% in acute symptomatic seizures, 37% in structural epilepsy, 5% in genetic epilepsy. Pyridoxine/pyridoxalphosphate was much more used in genetic epilepsy (as first-line in 26%, as second-line in 37%) than in the other two conditions. Long-term conventional EEG monitoring was suggested as important to verify efficacy of drugs in controlling seizures by 84% of interviewed neurologists, but EEG was available around the clock in only 53% of their centers. 1 to 3-channel aEEG/EEG (commonly named CFM) was often used instead of conventional EEG monitoring. Conclusion: This is the first survey looking at a targeted approach in treatment of neonatal seizures by pediatric neurologists consulted by NICUs. The treatment approach is similar to previous surveys in case of acute symptomatic seizures, but in case of other etiologies the choices are different, especially for the second-line option. Larger studies should address this topic.

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