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Long-term antiseizure medication may be unnecessary for infants

August 1, 2021

Forgoing long-term medication in babies who had a seizure did not impact their neurodevelopment, motor skills or risk of future seizures at 24 months, a study found.

Each year, more than 16,000 newborns in the U.S. have a seizure, according to the Patient-Centered Outcomes Research Institute. Studies have raised concerns about long-term antiseizure medications having neurotoxic effects.

Researchers set out to study the impact of discontinuing antiseizure medication after hospital discharge. They enrolled 303 neonates with acute symptomatic seizures from nine U.S. Neonatal Seizure Registry centers. About 43% had hypoxic-ischemic encephalopathy, 26% had ischemic stroke, 18% had intracranial hemorrhage and 13% had another acute brain injury.

The babies underwent continuous electroencephalogram (EEG) monitoring. After hospital discharge, 64% maintained antiseizure medication, most commonly phenobarbital monotherapy. Infants were on the medication for a median of four months compared to six days for those who discontinued it before discharge.

At 24 months, children’s functional neurodevelopment was assessed with the Warner Initial Developmental Evaluation of Adaptive and Functional Skills, which asks about mobility, communication, social cognition and self-care. Motor function was assessed with the Gross Motor Function Classification System.

Among 270 children evaluated at 24 months, both adjusted and unadjusted neurodevelopmental scores were four points higher for those who discontinued medication before hospital discharge. There was no significant difference in motor function scores.

In the weeks after hospital discharge, none of the children who discontinued medication had a seizure. About 13% of all children in the study developed epilepsy by 24 months. However, there was no significant difference in risk between the group that stopped medication and the group that continued it.

“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,” co-principal investigator and lead author Hannah C. Glass, M.D.C.M., M.A.S., said in a news release.

Authors said they believe it is safe for most infants to discontinue antiseizure medication after 72 hours without a seizure, regardless of whether the infant’s EEG was abnormal.

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