Study: 'Rethink' use of antiseizure medications after hospital discharge in neonates

Researchers observed no difference in functional neurodevelopment or epilepsy among children aged 24 months regardless of whether antiseizure medication was discontinued or maintained in infants at discharge once seizures ceased.

Results of the comparative effectiveness study were published in JAMA Neurology.

“These results support discontinuing antiseizure medications (ASMs) for most neonates with acute symptomatic seizures prior to discharge from the hospital, an approach that may represent an evidence-based change in practice for many clinicians,” Hannah C. Glass, MDCM, MAS, a pediatric neurologist, founding codirector of the neurointensive care nursery and director of neonatal critical care services at the University of California, San Francisco Benioff Children’s Hospital, and colleagues wrote.

ASMs can be maintained in infants for months or years unnecessarily, according to the researchers, due to concerns over continued seizures and early-life epilepsy. Glass and colleagues investigated the impact of early discontinuation of ASM after acute symptomatic neonatal seizures resolved but prior to hospital discharge on functional neurodevelopment and risk for epilepsy at 24 months of age.

This prospective, observational, multicenter comparative effectiveness study enrolled 303 infants with acute symptomatic neonatal seizures who were born between July 2015 and March 2018 and enrolled at nine Neonatal Seizure Registry centers with level IV neonatal ICUs and pediatric epilepsy programs. The study included slightly more male infants (56%) than female infants.

Glass and colleagues continuously monitored infants using a conventional electroencephalogram. Dosing and treatment were employed under the advisement of local health care professionals. The researchers collected data on ASM type, discontinuation or maintenance and timing and dosage of medication. The researchers also analyzed demographic, clinical and primary seizure causation factors. Parents of the infants reported neurodevelopmental outcomes at 12, 18 and 24 months, corroborated by a medical record review. The primary outcome of the study was functional neurodevelopment at 24 months, which Glass and colleagues measured using the Warner Initial Development Evaluation of Adaptive and Functional Skills questionnaire (WIDEA-FS).

Among the 303 infants, 43% of seizures was caused by hypoxic-ischemic encephalopathy, 26% by ischemic stroke, 18% by intracranial hemorrhage and the remaining 13% by another acute brain injury.

The local health care professionals prescribed phenobarbital as the first loading ASM in 90% of infants. Upon discharge, a majority (64%) of patients were maintained on ASMs (P < .001). ASM maintenance occurred more often in infants with high seizure burdens, complex clinical courses and abnormal neurological findings at time of discharge. The median treatment length on ASMs in infants with maintained ASMs was 4 months compared with 6 days among those whose medication was discontinued.

In the 270 children who returned at 24 months of age for follow-up, the median WIDEA-FS score was 164, with slightly higher scoring (+4 points; 2%) in children whose medication was discontinued prior to a hospital discharge (37%). However, the researchers observed no difference between the two cohorts with regard to functional neurodevelopment or epilepsy at 24 months.

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

Reference:

Michigan Health Lab. Babies with seizures may be overmedicated. Available at: https://labblog.uofmhealth.org/rounds/babies-seizures-may-be-overmedicated. Accessed May 26, 2021.