TREATMENT OF NEONATAL SEIZURES WITH CARBAMAZEPINE

Carbamazepine has been used in adults and children for over 30 years. In spite of an excellent therapeutic and side-effect profile in older children, it has never been used as a primary anticonvulsant in neonat es. This is the first report of the longterm use of carbamazepine in n eonates. Ten full-term neonates with two or more seizures due to hypox ic-ischemic encephalopathy were given 10 mg/kg of carbamazepine as a l oading dose via nasogastric tube, Twenty-four hours later the first fi ve patients began a maintenance regimen of 21 mg/kg/daily, and the rem aining five patients began a maintenance regimen of 15 mg/kg/daily, al l via nasogastric tube. Therapy was continued for 3 to 9 months. Drug levels were monitored every 2 to 4 hours during the first 24 hours, an d on days 2, 4, 8, 15, 30, 45, and 60, and monthly thereafter. Absorpt ion of carbamazepine was excellent even in sick neonates. Therapeutic levels were reached in 2 to 4 hours in all patients, Peak levels were achieved in 4 to 16 hours (mean, 9.2 +/- 4.2). Elimination half-life w as 24.5 hours. Levels dropped precipitously around 8 to 15 days and th ereafter declined slowly over the next 3 months. Seizure control was e xcellent; only two patients had one seizure each during the first 10 h ours. There were no gastrointestinal, hepatic, hematologic, renal, or dermatologic side effects. This preliminary study shows that carbamaze pine may be an effective anticonvulsant for neonatal seizures.