Problems of the therapy of neonatal convulsions

: The newborn with seizures should be treated urgently, because of the high risk of consequent brain damage. In addition to general management in order to correct metabolic and functional unbalancement, associated with the fits, specific causes of neonatal seizures (hypoglicemia, hypocalcemia, hypomagnesiemia, hypo-hypernatremia, pyridoxine deficiency) should be immediately removed. If neonatal seizures depend on other non specific causes (anoxia, cerebral hemorrhagy, malformation, infection or other, a symptomatic anticonvulsant treatment should be carried out without delay. Useful drugs for the newborn are phenobarbital, phenytoin and benzodiazepine e.v. or e.m. After fits have been controlled, an oral maintenance therapy has to be started with phenobarbital or phenytoin in order to avoid seizure-relaps. Clinical EEG and hematological data should be monitored to detect side effects, as well as plasma drugs levels to achieve adequate maintenance doses. Criteria for discontinuing the neonatal seizures treatment have not been well established. On the bases of the data collected through a longitudinal study of 54 newborns who developed seizures in the first day of life, clinical and EEG criteria for discontinuing anticonvulsant therapy are discussed. If the fits are rare, short, immediately controlled and EEG is mildly abnormal, we attempt to discontinuing treatment within 15 days. If fits are unfrequent, varying in length, their therapeutical control is reached within 3 days and the EEG is markedly abnormal but recovered within 1 month, treatment is discontinuing between 15 days and 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)