Study shows newborns with seizures may be overmedicated

Study shows newborns with seizures may be overmedicated
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A new study has shown that babies on long-term antiseizure medication may be overmedicated, as continued administration of the medicines may not prevent continued seizures or epilepsy, or change development.

The new multicentre study has suggested that continuing antiseizure treatment after neonatal seizures stop may not be necessary as babies who stayed on antiseizure medications after going home were not any less likely to develop epilepsy or to have developmental delays than those who discontinued the medicines before leaving hospital.

The findings have been published in JAMA Neurology.

Antiseizure medication

The study suggests that keeping newborns on longer-term antiseizure medication may not prevent continued seizures or epilepsy or change development.

Newborns with seizures are at risk of developing long-term chronic conditions, such as developmental delays, cerebral palsy, or epilepsy. They receive medication to treat the electrical brain disturbances right away out of concern that seizures may reoccur. However, the new study suggests this may not be the case.

Renée Shellhaas, M.D., M.S., paediatric neurologist at University of Michigan C.S. Mott Children’s Hospital, said: “There is wide variability in how different hospitals and physicians manage care for newborns with seizures.”

“Our findings suggest that staying on antiseizure medication after leaving the hospital doesn’t protect babies from continued seizures or prevent epilepsy and it does not change developmental outcomes,” says lead author for the study, Hannah C. Glass, MDCM, MAS., a paediatric neurologist at the University of California, San Francisco Benioff Children’s Hospital.

The risks of overmedication

Long-term use of antiseizure medicine may expose babies to potentially neurotoxic effects, and research indicates this may be associated with lower cognitive scores. Currently, the most used medication for neonatal seizures is phenobarbital, which slows down brain activity but causes sedation, and newborns who are prescribed this kind of medication may also have more trouble waking up to feed and engaging in other types of activities that are important to growth and development.

Shellhaas said: “We really need to balance the risks of continued medication with benefits to babies’ health. If it’s not necessary, then keeping them on medicine could do more harm than good.”

“Most of the babies in this study went home on antiseizure medications, which suggests we need to re-think standard practice,” adds Glass. “We’ve never had such robust data from multiple centres to support this type of change for newborns with seizures.”

The team will continue to follow this cohort of infants up to school age to assess development, including sensory processing, IQ, and potential learning disabilities through research supported by the National Institutes of Health.

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