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1096 Enigma of Management of Seizures in Hypoxic Ischemic Encephalopathy (HIE) - When to Stop Anticonvulsants?
  1. S Nangia1,
  2. A Saili1,
  3. A Garg2
  1. 1Division of Neonatology, Department of Pediatrics
  2. 2Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India

Abstract

Background Although there is some agreement regarding what and when to initiate as anticonvulsant medication for seizures in HIE, there is no consensus about when to stop medication.

Objective To assess the effect of early stoppage of anticonvulsant drugs in HIE on seizure recurrence and neurological outcome.

Design/methods This prospective study enrolled neonates with HIE with non-metabolic seizures from August 2007 to July 2010. A loading dose of 20mg/kg of phenobarbitone was used for seizure control. Additional mini-boluses of 5mg/kg till a cumulative dose of 40mg/kg followed by phenytoin was used if required.

Results Out of 59 neonates, 85% had cord pH below 7.2 and 83% had BE of –12 or higher. At birth 89% required positive pressure ventilation and 40% needed mechanical ventilation during NICU stay. 26/59(44%) had seizure onset before 6 hrs and 23/59 (39%) between 6–12 hrs. 64% had a single episode of seizure, 22% had 2–3 episodes and 10% had 4–6 episodes. Twelve babies expired and 47 were discharged without anticonvulsant. There was no recurrence of seizure in 44/47(94%). On follow up at 3 months 40/47(85%), at 6 months 30/35(86%), at 12 months 25/29(86%), at 24 months 23/26 (89%) and at 30 months 13/16(81%) had normal neurological outcome.

Conclusions This pilot work suggests that potentially apoptotic anticonvulsant drugs can probably be stopped early as soon as seizures abate in HIE without increased risk of seizure recurrence or adverse neurological outcome.

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