The new International League Against Epilepsy (ILAE) classification of seizures and epilepsies for neonates underscores that the diagnosis of seizures in the neonate relies on an EEG correlate. Stereotyped clinical events without an associated ictal rhythm on EEG are no longer to be treated or diagnosed as neonatal seizures.
Neonates with neonatal encephalopathy (NE) at high risk for brain injury should be considered for EEG monitoring as a standard of care, at least aEEG, and cEEG if available.
Treatment of seizures should be guided by detection of seizures by EEG, and not based on clinical observation alone.
cEEG/aEEG monitoring and assessment of the background pattern can inform the risk of developing seizures during the course of therapeutic hypothermia. Neonates with a normal background in the 24 h have a very low risk of developing seizures.
Phenobarbital continues to be the recommended choice for first-line therapy for neonatal seizures in the context of NE.
Emerging evidence suggests that ASMs can be safely discontinued after acute seizures resolve and prior to hospital discharge.