Treatment of seizures in infants

The treatment of seizures in newborns and infants is determined by the type of seizure and its cause. In some cases, no therapy is needed because the seizure is an isolated event, such as a single seizure associated with a high fever. In very rare cases, replacement of a missing nutrient can stop further seizures, as in low blood sugar levels or a calcium or vitamin B6 deficiency in a newborn.

But most of the time, babies who have epilepsy must be treated with seizure medicines. As with any other age group, doctors try to balance the benefits of seizure control against the risks of adverse effects from the medicines.

This raises an important question if a baby with epilepsy is also developmentally delayed: What is causing the delay—the seizures, the abnormalities (called "epileptiform discharges") found on the EEG, the medicines, or the underlying problem? This question is difficult to answer. It can be impossible to answer for sure, because when one factor changes, it can change the others. For example, lowering the dosage and the number of seizure medicines reduces the potential side effects but may make the seizures worse. If a CT or MRI scan shows evidence of a brain abnormality, the structural problem is probably a major cause of the developmental delay, but such babies also may be extra-sensitive to the effects of seizures and medications. Despite the difficulties, these questions should be addressed. Rarely, there must be a trade-off to get the best results.

Paediatricians and family physicians are often the first to treat babies with seizures, but they usually refer these infants to a paediatric neurologist for consultation or long-term care because epilepsy in the first year of life may be caused by underlying neurological problems, and it is often challenging to properly diagnose and treat. Especially complex or difficult cases may need further referral to a paediatric epileptologist at a comprehensive epilepsy centre.

Topic Editor:James W. Wheless, M.D.
Last Reviewed:10/5/06

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