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Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions

Seizures are common in newborn infants with hypoxic-ischemic encephalopathy and are highly associated with adverse neurodevelopmental outcomes. The impact of seizure activity on the developing brain and the most effective way to manage these seizures remain surprisingly poorly understood, particular...

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Autores principales: Zhou, Kelly Q., McDouall, Alice, Drury, Paul P., Lear, Christopher A., Cho, Kenta H. T., Bennet, Laura, Gunn, Alistair J., Davidson, Joanne O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268683/
https://www.ncbi.nlm.nih.gov/pubmed/34281174
http://dx.doi.org/10.3390/ijms22137121
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author Zhou, Kelly Q.
McDouall, Alice
Drury, Paul P.
Lear, Christopher A.
Cho, Kenta H. T.
Bennet, Laura
Gunn, Alistair J.
Davidson, Joanne O.
author_facet Zhou, Kelly Q.
McDouall, Alice
Drury, Paul P.
Lear, Christopher A.
Cho, Kenta H. T.
Bennet, Laura
Gunn, Alistair J.
Davidson, Joanne O.
author_sort Zhou, Kelly Q.
collection PubMed
description Seizures are common in newborn infants with hypoxic-ischemic encephalopathy and are highly associated with adverse neurodevelopmental outcomes. The impact of seizure activity on the developing brain and the most effective way to manage these seizures remain surprisingly poorly understood, particularly in the era of therapeutic hypothermia. Critically, the extent to which seizures exacerbate brain injury or merely reflect the underlying evolution of injury is unclear. Current anticonvulsants, such as phenobarbital and phenytoin have poor efficacy and preclinical studies suggest that most anticonvulsants are associated with adverse effects on the developing brain. Levetiracetam seems to have less potential neurotoxic effects than other anticonvulsants but may not be more effective. Given that therapeutic hypothermia itself has significant anticonvulsant effects, randomized controlled trials of anticonvulsants combined with therapeutic hypothermia, are required to properly determine the safety and efficacy of these drugs. Small clinical studies suggest that prophylactic phenobarbital administration may improve neurodevelopmental outcomes compared to delayed administration; however, larger high-quality studies are required to confirm this. In conclusion, there is a distinct lack of high-quality evidence for whether and to what extent neonatal seizures exacerbate brain damage after hypoxia-ischemia and how best to manage them in the era of therapeutic hypothermia.
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spelling pubmed-82686832021-07-10 Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions Zhou, Kelly Q. McDouall, Alice Drury, Paul P. Lear, Christopher A. Cho, Kenta H. T. Bennet, Laura Gunn, Alistair J. Davidson, Joanne O. Int J Mol Sci Review Seizures are common in newborn infants with hypoxic-ischemic encephalopathy and are highly associated with adverse neurodevelopmental outcomes. The impact of seizure activity on the developing brain and the most effective way to manage these seizures remain surprisingly poorly understood, particularly in the era of therapeutic hypothermia. Critically, the extent to which seizures exacerbate brain injury or merely reflect the underlying evolution of injury is unclear. Current anticonvulsants, such as phenobarbital and phenytoin have poor efficacy and preclinical studies suggest that most anticonvulsants are associated with adverse effects on the developing brain. Levetiracetam seems to have less potential neurotoxic effects than other anticonvulsants but may not be more effective. Given that therapeutic hypothermia itself has significant anticonvulsant effects, randomized controlled trials of anticonvulsants combined with therapeutic hypothermia, are required to properly determine the safety and efficacy of these drugs. Small clinical studies suggest that prophylactic phenobarbital administration may improve neurodevelopmental outcomes compared to delayed administration; however, larger high-quality studies are required to confirm this. In conclusion, there is a distinct lack of high-quality evidence for whether and to what extent neonatal seizures exacerbate brain damage after hypoxia-ischemia and how best to manage them in the era of therapeutic hypothermia. MDPI 2021-07-01 /pmc/articles/PMC8268683/ /pubmed/34281174 http://dx.doi.org/10.3390/ijms22137121 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Zhou, Kelly Q.
McDouall, Alice
Drury, Paul P.
Lear, Christopher A.
Cho, Kenta H. T.
Bennet, Laura
Gunn, Alistair J.
Davidson, Joanne O.
Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions
title Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions
title_full Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions
title_fullStr Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions
title_full_unstemmed Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions
title_short Treating Seizures after Hypoxic-Ischemic Encephalopathy—Current Controversies and Future Directions
title_sort treating seizures after hypoxic-ischemic encephalopathy—current controversies and future directions
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268683/
https://www.ncbi.nlm.nih.gov/pubmed/34281174
http://dx.doi.org/10.3390/ijms22137121
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