Neonatal Seizures: Current Management and Future Challenges

L. Nagarajan ed. Neonatal Seizures: Current Management and Future Challenges (International Review of Child Neurology Series) London, UK: Mac Keith Press; 2016 (214 pages).ISBN 978–1-909962–67–5 / £44.99

Neonatal seizures are challenging for neonatologists, neurologists, and all those who treat critically ill neonates. Comprehensive books in neonatal seizures are rare, and in a vast majority, older than 20 years. For this reason, the authors deserve a special credit for putting together a book with the goal to satisfy the expectations of both specialists and medical students. To put it straight: This book meets the expectations.

Twelve chapters from different authors, the majority renowned experts in their fields, address all aspects of neonatal seizures. Framed by two chapters on basic science “Development of the neonatal cerebral cortex” and “Neuroprotective strategies for neonates with seizures,” the remaining ten chapters deal with diagnostic, therapeutic, and prognostic aspects of neonatal seizures. Repetitions are inherent in a multi-author opus, but do not impair quality. The chapters are written in a structured and clear style. The cited literature is comprehensive and very up-to-date and offers the reader the chance to access additional information on the respective topics. Three chapters about continuing video-electroencephalogram (EEG) monitoring, standard 1-hour video-EEG and amplitude-integrated EEG impart knowledge about the merits and demerits of these techniques and give recommendations regarding the application of these diagnostic tools. The figures on EEG and amplitude integrated EEG are carefully selected and well prepared. The topic is completed by techniques for automated seizure detection, which however, is not yet ready for incorporation into routine clinical practice. The overview on neuroimaging covers several etiologies of neonatal seizures and their presentation in ultrasound, magnetic resonance imaging, and magnetic resonance spectroscopy. Although the figures are rather small, they are exemplary and instructive. Less educative are the short contributions about near-infrared spectroscopy and magnetoencephalography, which are not yet part of routine diagnostics in neonatal seizures. The expanding knowledge on the genetic background of neonatal epilepsies and epileptic encephalopathies and the related new insights in neonatal seizure mechanisms are summarized in chapter 7. The new disease entities are completed and linked with the known neonatal epileptic syndromes “Benign familial neonatal epilepsy,” “Early myoclonic encephalopathy,” “Ohtahara Syndrome” and “Migrating seizures.” Here too, the figures are well selected and illustrative. Chapter 9 contains a comprehensive overview on first- and second-line antiepileptic drugs, their mode of action, safety aspects, and suggested dosages. This excellent summary is a very helpful source for a quick orientation on anticonvulsive options and dosages in drug refractory neonatal seizures or neonatal status epilepticus. The role of EEG and imaging as predictors of outcome for neonates with seizures are extensively discussed in chapter 10. In chapter 11, the key role of neonatal seizures for later epilepsy, neurodevelopmental sequelae, cerebral palsy, and intellectual disabilities is comprehensively reviewed.

It is difficult to find something to criticize in this book. Chapter 8, devoted to “Clinical approach to a neonate with seizures,” possibly failed to fully fulfil my expectations. The chapter includes many repetitions on topics better outlined in other chapters and the presentation of the “clinical approach” is improvable. A diagnostic and/or therapeutic algorithm would have perfectly complemented this book. Nonepileptic paroxysmal events are too briefly discussed. In daily practice, wrong allocation to epileptic or nonepileptic events is a major problem and might have serious consequences for the newborn. A broader discussion of this aspect is therefore desirable.

Overall, this is an excellent and highly important contribution. I congratulate the authors and I agree with Prof. Gregory L. Holmes, who provided the foreword, that Prof. Lakshmi Nagarajan deserves great praise for bringing this book to fruition. Everybody who handles neonates and neonatal seizures should have access to this book as a source for current knowledge and developments in neonatal seizures.