Welcome to the WCN 2023 Interactive Program

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Seizures are the most common neurological emergency in the neonatal period and are associated with mortality and long-term neuro-disability. The clinical diagnosis is challenging because most have no or only discreet clinical manifestations. Depending on the etiology, up to 60% of seizures are electrographic only. Critically ill infants with a very high seizure burden or in status epilepticus are particularly likely to lack clinical manifestation. Thus, clinical diagnosis is unreliable in most cases making EEG or aEEG diagnosis a necessity. This makes the integration into a classification serving all ages difficult. Recently the ILAE has published a position paper outlining a new classification for neonatal seizures to provide neonatologists, pediatricians and neurologists a common language to identify, diagnose, and treat neonatal seizures and their acute aetiologies. This classification uses the same framework and terminology as the 2017 ILAE seizure classification but is tailored toward neonates. All neonatal seizures are considered of focal onset and should be confirmed electrographically. Seizure types include motor events (automatisms, clonic, epileptic spasms, myoclonic, sequential, tonic) or non-motor events (autonomic, behavior arrest) or electro-graphic only. It allows the user to choose the degree of detail when classifying seizures while taking underlying pathophysiological mechanisms into account. We also defined diagnostic certainties according to the methods available (EEG, aEEG or clinical only). A further position paper has been published recently defining and outlining epilepsy syndromes with onset in the neonatal period and infancy.

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Seizures are a common neurological emergency in the neonatal period. Most seizures in newborns are acutely provoked, in about 10-15% of infants, seizures are the manifestation of a neonatal epilepsy. A guideline on management of neonatal seizures was published by the World Health Organization (WHO), the International League Against Epilepsy (ILAE) and the International Bureau of Epilepsy (IBE) in 2011. An ILAE taskforce comprised of pediatric epileptologists, neonatologists, child neurologists, methodologists and a patient representative over the last years aimed to update the recommendations on pharmacological treamtent of neonatal seizures. Six clinical priority questions were identified, and addressed via a systematic review of the literature with subsequent evaluation of the evidence if possible using GRADE and a Delphi process when evidence was lacking, in accordance with ILAE standards regarding clinical practice guideline development. The guideline is currently under review.

For each of the six clinical priority questions, the talk will focus on the results of the systematic literature review as well as evidence based recommendations and expert opinions. It aims to highlight challenges in treating neonatal seizures, to help the audiance to recognize the need for standardized treatment guidelines and to point out knowledge gaps and research priorities.

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The updated treatment guidelines follow on from the previous WHO/ILAE report with much needed updates on management and care. The classification and treatment guidelines represent the gold standard approaches, inevitably many of the recommendations are not viable in resource poor settings and need to be safely adapted for the local setting. Insight into critical approaches are essential for prevention of brain insults leading to seizures as much as addressing early and critical symptomatic causes of neonatal seizures. This would include early intervention for hypoglycaemia, electrolyte imbalance and underlying infections. Even in resouce limited settings access to aEEG needs to be advocated for. Similarly following innovative equipment to support implementation of therapeutic hypothermia for neonates at risk of HIE.