Dylematy diagnostyczne i wyzwania terapeutyczne w padaczkach noworodków: perspektywa neurologa
Diagnostic Dilemmas and Therapeutic Challenges in Neonatal Seizures: A Neurology Perspective
W skrócie
[Preprint - wstępne wyniki] Padaczki u noworodków są trudne do zdiagnozowania, ponieważ wiele z nich występuje tylko w zapisie EEG bez widocznych objawów, a różne incydenty mogą naśladować prawdziwe padaczki. Leczenie stanowi również wyzwanie - lekarze debatują, kiedy leczyć, jakim lekiem i jak długo, zwłaszcza że nie ma jednej przyjętej strategii, a nowe drogie terapie zwiększają nierówności w dostępie do opieki. Przegląd ten omawia główne problemy diagnostyczne i terapeutyczne, z którymi spotyka się lekarz podczas leczenia noworodków z padaczką.
Oryginalny abstract (angielski)
Seizures occur more frequently in the neonatal period than at any other time in life. Seizures and epileptic burden in the neonatal period- is correlated to neurodevelopmental outcomes and overall prognosis. Accurate diagnosis is essential for appropriate management; however, there are many diagnostic dilemmas. Seizures in the neonatal period are difficult to diagnose accurately. Many seizures are electrographic only with no clinical correlates, different kinds of paroxysmal events in neonates may mimic electroclinical seizures, and diagnosis based on clinical phenomena alone may result in inaccuracies . There is no universally accepted definition of a neonatal seizure or neonatal status epilepticus (Conventional EEG (CEEG) is the gold standard for diagnosis of a neonatal seizure. Continuous conventional video EEG monitoring (cVEEG) for 24 to 48 hours may be needed for detecting seizures in those at risk, to monitor therapy and to assess epileptic burden; it is not available for clinical care in most parts of the world . There are many therapeutic challenges in the treatment of seizures in the neonate. Most neonatal seizures are provoked or due to symptomatic aetiology. Genetic, metabolic and structural epilepsies are less frequent causes for neonatal seizures. The treatment paradigm is often similar initially, till a specific aetiology is suspected or identified. When to treat, what to treat with, how much to treat, and how long to treat are still being debated, with no uniform strategy. Early distinction between provoked seizures and neonatal onset epilepsy is important to guide therapy. The emergence of targeted therapies (some quite expensive), while exciting, has added to the therapeutic challenges and inequities associated with management of neonates with seizures. This review addresses many of the diagnostic dilemmas and therapeutic challenges encountered by a clinician in the management of neonates with seizures.