Treatment of frequent neonatal seizures and status epilepticus

This algorithm represents our suggested approach to the treatment of neonates with frequent seizures or status epilepticus. Refer to UpToDate topics on neonatal seizures for full details.

ASM: antiseizure medication; EEG: electroencephalography; ILAE: International League Against Epilepsy; IV: intravenous; MRI: magnetic resonance imaging; PE: phenytoin equivalents.

* This approach is recommended by the ILAE for neonates without evidence for neonatal-onset epilepsy^[1]. However, some experts advise caution about stopping ASM for neonates with significant abnormalities on EEG, brain MRI, or neurologic examination.

¶ Adjust lidocaine dose for neonates with a low body weight (<2.5 kg) and those undergoing therapeutic hypothermia^[2]. Refer to accompanying UpToDate text and separate table of lidocaine dosing for neonatal seizures.

References:

Pressler RM, Abend NS, Auvin S, et al. Treatment of seizures in the neonate: Guidelines and consensus-based recommendations-Special report from the ILAE Task Force on Neonatal Seizures. Epilepsia 2023.
van den Broek MP, Rademaker CM, van Straaten HL, et al. Anticonvulsant treatment of asphyxiated newborns under hypothermia with lidocaine: efficacy, safety and dosing. Arch Dis Child Fetal Neonatal Ed 2013; 98:F341.

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Treatment of frequent neonatal seizures and status epilepticus