Neonatal Seizure/Status Epilepticus — Other Conditions — Clinical Pathway: N/IICU

Neonatal Seizure/Status Epilepticus Clinical Pathway — N/IICU

Other Conditions

Major Congenital Heart Disease or Arrythmias
  • Levetiracetam may be preferred as 2nd Line ASM
  • Consult Neurology
Genetic Epilepsy
  • Suspicion for a channelopathy (neonatal onset epilepsy) based on family history and clinical information
    • Consider early use of sodium channel blockers (fosphenytoin/phenytoin, oxcarbazepine, and carbamazepine)
Metabolic Conditions
  • Consider vitamin responsive seizures in neonates if
    • No identified etiology
    • Continued seizures after 1st and 2nd line ASM
    • Typical seizure types: spasms, myoclonic seizures
    • Typical EEG characteristics: severely abnormal background
  • Pyridoxine
    • Performed with cEEG and respiratory support available
    • 100 mg IV, repeating 100 mg every 5-10 mins up to total 500 mg IV
    • Follow with 15-30 mg/kg/day divided TID PO for 3-5 days
  • Pyridoxal-5-Phosphate
    • 30-50 mg/kg/day divided TID PO for 3-5 day
  • Folinic Acid
    • 3-5 mg/kg/day divided BID PO for 3-5 days
  • If response or possible response, then continue treatment while specific metabolic/genetic testing is pending