Neonates With Acute Seizures May Be Overmedicated

Among neonates with resolution of acute symptomatic seizures, there is no difference in functional neurodevelopment or epilepsy at age 24 months for those discontinuing antiseizure medication (ASM) before hospital discharge versus maintaining medication, according to a study published online May 24 in JAMA Neurology.

Hannah C. Glass, M.D.C.M., from University of California, San Francisco, and colleagues used data from nine U.S. Neonatal Seizure Registry centers to evaluate the association between ASM discontinuation after resolution of acute symptomatic neonatal seizures (before hospital discharge) and functional neurodevelopment or risk for epilepsy at age 24 months. The analysis included data for 303 neonates, born from July 2015 to March 2018, who had acute symptomatic seizures.

The researchers found that most neonates (64 percent) had ASM maintained at the time of hospital discharge. Among 270 children with 24-month follow-up data (54 percent male), the Warner Initial Developmental Evaluation of Adaptive and Functional Skills score was similar for infants with ASM discontinuation versus infants with ASM maintained at discharge (median score, 165 versus 161; P = 0.09), with the propensity-adjusted average difference of 4 points meeting the a priori noninferiority limit of −12 points. Additionally, epilepsy risk was similar between the two groups (11 percent versus 14 percent; propensity-adjusted odds ratio, 1.5; P = 0.32).

"We really need to balance the risks of continued medication with benefits to babies' health," coauthor said in a statement. "If it's not necessary, then keeping them on medicine could do more harm than good."

Several authors reported financial ties to pharmaceutical companies and medical organizations.