Carbamazepine in phenobarbital-nonresponders: experience with ten preterm infants

Carbamazepine is a standard anticonvulsant in children and adults. Until no w there is only little information available on its use in neonates. We inv estigated the oral administration of carbamazepine in refractory neonatal s eizures treated with phenobarbital. Ten preterm infants (gestational age 23 + 6 - 34 + 6 weeks, birth weight 640 g-3080 g) with neonatal seizures were refractory to a primary therapy with phenobarbital. All patients subsequen tly received carbamazepine exclusively as a second choice anticonvulsant. A daily dose of 7-23 mg/kg carbamazepine was administered orally in two to t hree aliquots. All patients reached therapeutic plasma drug levels (3-12 mg /l; 13-50 mu mol/l). In nine out of ten patients (complete group of small p reterms with gestational age under 30 weeks and weight less than 1000 g), t herapeutic success was excellent. Carbamazepine was continued for 1-5 month s. After termination of therapy no further seizures occurred, also on EEG r ecordings. Finally, no carbamazepine-induced adverse effects were observed. Conclusion This is the first report on the use of carbamazepine in small pr eterm infants. Carbamazepine may provide a useful and effective oral mainte nance therapy in the management of neonatal seizures in these patients.