DR.RAHUL ANAND YADAV MD DM(NEONATOLOGY ...babathakranwala.in/iapneochap/uploads/neocon...
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DR.RAHUL ANAND YADAV
MD DM(NEONATOLOGY)
HOD KKCTH
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When to use?
Which type of seizures?
How much(dose of drug) to use?
How long to use?
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MANDAN MISHRA
SANKARACHARYA
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1)Eye witness
2)Logic
3)Guidelines by authority in subject
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Normal Neonatal Brain
Neonatal convulsions
Drug Action
Conclusions
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Disturbed balance between excitatory and inhibitory neurotransmitters
Excitatory:Glutamate
Inhibitory:GabaGlutamate
Gaba
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Subtle seizures
Multi focal clonic
Generalized tonic
Myoclonic
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•Depends upon levels of cytosolic calcium levels.
•When cytosolic calcium levels are high, signal to noise ratio is altered resulting in seizures.
•Levetiracetam inhibits the release and influx of calcium into cytosol thereby reducing the signal to noise ratio
•Synaptotagmin is a calcium sensor for exocytosis in pre synaptic vesicle leading to excitatory NT release into synaptic junction.
•SV2A regulates the activity of synaptotagmin leading to inhibition of calcium mediated exocytosis.
•Levetiracetam acts as an agonist of synaptic vesicle protein 2A
Signal to noise ratio SV2A agonist
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Can be used in neonates
Do not use in subtle and generalized tonic seizures
“Use in Myoclonic seizures, especially stimulus sensitive thalamocorticalmyoclonus”
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“DOES NOT EXIST”
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When to use?
Which type of seizure to use?
How much to use?
How long to use?
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DIAZEPAMStatus
Epilepticu
s
LEVETIRACET
AM4 hours
NOT
REDUCED
EPILEPSY
RISK
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LEVETIRACETAM PHENOBARBITONE
Respiratory depressant action absent
Myocardial depressant action absent
Metabolic demand:?
Multifocal clonic seizure:use unknown
Myoclonic:more useful
Drug interactions absent
Respiratory depressant action present
Myocardial depressant action present
Metabolic demand:Decreased
Multifocal clonic seizure:useful
Myoclonic: less useful Drug interactions
present
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LEVETIRACETAM VALPROATE
Liver dysfunction absent
In instances where there is increased levels of ammonia,it is safe
Pharmacoresistancenot seen(MDR protein)
Liver dysfunction present
In instances where there is increased levels of ammonia,it is unsafe
Pharmacoresistanceseen
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Loading dose :40mg/kg(some units start with 20mg/kg)
1cc=100mg… “Accidental overdose reported but non fatal!” Maintainance dose
< 7 days-10mg/kg q8h> 7 days-20mg/kg q12h
Can use higher doses in exceptional circumstances
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Dentate gyrus is a part of Hippocampus
Involved in episodic memory formation and exploration of new environment
LEV ,on prolonged use has potential side effects due to effect on dentate gyrus
Manifestations include Hyperactivity,psychosis ,tremors
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Routinely don’t use
Can be used in stimulus sensitive myoclonic convulsions
Higher doses tolerated better
Stop as soon as primary etiology is better