Treating Seizures after Hypoxic-Ischemic Encephalopathy-Current Controversies and Future Directions
| Autor: | Kenta H T Cho, Christopher A. Lear, Laura Bennet, Kelly Q Zhou, Alice McDouall, Paul P. Drury, Joanne O. Davidson, Alistair J. Gunn |
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| Rok vydání: | 2021 |
| Předmět: |
Phenytoin
medicine.medical_specialty QH301-705.5 medicine.medical_treatment levetiracetam Encephalopathy Brain damage Review therapeutic hypothermia Catalysis Hypoxic Ischemic Encephalopathy Inorganic Chemistry 03 medical and health sciences 0302 clinical medicine Hypothermia Induced Seizures 030225 pediatrics Medicine Animals Humans hypoxic-ischemic encephalopathy antiepileptic drugs Physical and Theoretical Chemistry Biology (General) Intensive care medicine Molecular Biology QD1-999 Spectroscopy Randomized Controlled Trials as Topic business.industry Organic Chemistry Brain General Medicine asphyxia Hypothermia medicine.disease Computer Science Applications Chemistry Anticonvulsant Phenobarbital Hypoxia-Ischemia Brain Anticonvulsants Levetiracetam medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | International Journal of Molecular Sciences International Journal of Molecular Sciences, Vol 22, Iss 7121, p 7121 (2021) |
| ISSN: | 1422-0067 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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