Controversies in treatment of neonatal seizures are addressed by neurologists from Stanford and Yale Universities. Seizures likely to be associated with electrographic seizure activity (eg focal clonic or multifocal clonic seizures) should be treated with antiepileptic drugs (AEDs). Bilateral tonic posturing, unaccompanied by EEG seizure activity, would not be benefited by AEDs. The presence of seizures should be determined electrographically before treatment is begun. For symptomatic seizures, AEDs are administered until clinical seizures, but not necessarily all EEG seizures, are controlled. The nature and severity of the underlying cerebral lesions are the major determinants of outcome. Conventional treatment, usually with phenobarbital, is not very effective; control is obtained in only one-third of patients. The goals are to restore a normal metabolic state, control hypertension and tachycardia, and reduce the increase in glucose utilization. [1]

COMMENT. Seizures caused by hypoxic-ischemic encephalopathy and intracranial hemorrhage are the most refractory to treatment with AEDs. Seizures due to metabolic abnormalities are usually transitory and require early recognition and specific management. Water intoxication as a potential etiology of seizures in young infants, a previously rare condition, is increasing to epidemic proportions in US inner cities [2]. The maternal motivation for offering water remains uncertain. Improper dilution of formula and feeding large amounts of free water or glucose water, especially at times of diarrhea, are common practices, and occasionally result from improper medical advice. Infants with seizures refractory to AEDs should be tested for hyponatremia.