Advances in Neonatal Seizures (2024): An Update for Pediatricians.

Purpose: The diagnosis and management of seizures and epilepsy syndromes with onset in neonates has undergone several changes following the Internation League against Epilepsy (ILAE) guidelines. To update the Pediatricians regarding the recent advances, this update was planned.

Methods: Recently published revised guidelines for neonatal seizures (up to 2024) by ILAE were reviewed and synthesized.

Results: Video-EEG recording is considered gold standard for diagnosis, with less emphasis on clinical semiology. In resource limited settings, levels of diagnostic certainties may be used. One must be aware of the mandatory, alerts and exclusion criteria for various neonatal-onset epilepsy syndromes. Early neuroimaging facilitates diagnosis. Treatment primarily involves phenobarbitone (PHB) with other drugs to be used in certain special conditions, with universal early stoppage of drugs. Precision therapy is available for some metabolic and genetic etiologies.

Conclusions: EEG monitoring in high-risk neonates is the standard of care. PHB still remains the first choice. Early cessation of anti-seizure medications in acute symptomatic seizures is the norm.