Insights from a single-center study: Cessation of Anti-seizure Medication in Neonatal seizures

INTRODUCTION: Seizure susceptibility is greatest during the neonatal period of life. Early termination of these seizures is recommended by studies to prevent unfavorable long-term outcomes. We investigated the factors for ceasing anti-seizure medication in infants who experienced seizures during the neonatal period.
METHODS: This retrospective, single-center, descriptive study was conducted in tertiary medical center between December 2020 and February 2023, and 157 neonates were recruited. The possible confounding factors identified by the univariate analysis and the multivariate studies' logistic regression analysis was used to identify independent predictors for cease anti-seizure medication (ASM) at the infancy. The sensitivity, specificity, positive, and negative predictive values were displayed when a significant cut-off value was found by Receiver Operating Characteristic curve analysis.
RESULTS: Having a younger age at the first seizure (younger than 45.5 hours), using poly-therapy at the neonatal intensive care unit discharge, the presence of structural abnormalities in the brain related to the etiology of seizures, increased spike activity and burst suppression in EEG records decreased the likelihood of cease ASM before 12 months. The probability of cease ASM before 12 months was increased with a normal EEG.
DISCUSSION AND CONCLUSION: Our findings support that EEG and neuroimaging findings are the key factors for making decisions in the follow-up of infants with neonatal seizures. The potential long-term negative effects of ASM consumption can be reduced by discontinuing its use, when EEG results are normal. However, the etiology of structural abnormalities and the use of poly-therapy at the NICU discharge require caution in making early ASM discontinuation decisions.