Phenobarbitone in Neonatal Seizures: Controversies

Seizures are defined clinically as a paroxysmal alteration in neurologic function, i.e., motor, behaviour and/or autonomic function. Seizures are the most important signal of neurological disease in the neonatal period. They occur in 1-5% of the new-borns. The incidence is higher during this period than in any other period in life. It is important to treat seizures because of the potential adverse effects of seizure on respiratory function, circulation, cerebral metabolism and brain development. If aEEG is being used, termination of all electrical seizure activity should be the goal of therapy. Though mortality due to neonatal seizures has decreased from 40% to about 20% over the years, the prevalence of long term neurodevelopmental sequel has remained almost unchanged at around 30%. This signifies that the treatment of neonatal seizures is still inappropriate and there is a potential for improvement. Current guidelines are based on limited clinical data. The controversies regarding the best first line agent, second line agent, dose and duration, monitoring the drug levels still continue.