Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence‐based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta‐analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non‐randomised studies ‐ of interventions (ROBINS‐I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). If insufficient evidence was available, then expert opinion was sought using Delphi consensus methodology. The strength of recommendations was defined according to the ILAE Clinical Practice Guidelines development tool. There were six main recommendations. First, phenobarbital should be the first‐line ASM (evidence‐based recommendation) regardless of etiology (expert agreement), unless channelopathy is likely the cause for seizures (e.g., due to family history), in which case phenytoin or carbamazepine should be used. Second, among neonates with seizures not responding to first‐line ASM, phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second‐line ASM (expert agreement). In neonates with cardiac disorders, levetiracetam may be the preferred second‐line ASM (expert agreement). Third, following cessation of acute provoked seizures without evidence for neonatal‐onset epilepsy, ASMs should be discontinued before discharge home, regardless of magnetic resonance imaging or electroencephalographic findings (expert agreement). Fourth, therapeutic hypothermia may reduce seizure burden in neonates with hypoxic–ischemic encephalopathy (evidence‐based recommendation). Fifth, treating neonatal seizures (including electrographic‐only seizures) to achieve a lower seizure burden may be associated with improved outcome (expert agreement). Sixth, a trial of pyridoxine may be attempted in neonates presenting with clinical features of vitamin B6‐dependent epilepsy and seizures unresponsive to second‐line ASM (expert agreement). Additional considerations include a standardized pathway for the management of neonatal seizures in each neonatal unit and informing parents/guardians about the diagnosis of seizures and initial treatment options.

Objectives– To study the efficacy, tolerability and safety of the vagus nerve stimulation (VNS) therapy in clinical practice, in 16 children and adolescents with refractory epilepsy. Methodology– We...

Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world the discipline of pediatric neurology is recognized as a specialty or subspecialty of either Neurology or Pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurological conditions in children and the impact on their families. As the first part of a multi-staged project under the auspices of the International Child Neurology Association, in collaboration with key stakeholders, a survey was undertaken to establish which countries have practicing child neurologists. For those countries that have child neurologists, the survey established the number of practitioners, and which countries have access to in-country child neurology training. Responses were obtained from 177 countries. Worldwide there is a median of 0.07 and mean of 0.39 child neurologists per 100 000 population. The greatest deficits in child neurology specialists and access to training were evident in countries which fell under the world bank rating of low income country status (range of 0 to 0.008 child neurologists per 100 000 population). Seventy-three percent of low income countries lack access to child neurologists: the majority are in the African and South-East Asia Regions. For the population of 1.37 billion in the continent of Africa there were 324 child neurologists, equating to median 0.01 per 100 000 population in comparison to a median of 0.59 child neurologists per 100 000 across high income countries. Ninety-four countries had capacity to support in-country pediatric neurology training. Worldwide there are inadequate numbers of child neurologists and great need for increased training capacity.

This diagnostic accuracy study compared the accuracy of seizure detection by amplitude-integrated electroencephalography with the criterion standard conventional video EEG in term and near-term infants at risk of seizures. Simultaneous recording of amplitude-integrated EEG (2-channel amplitude-integrated EEG with raw trace) and video EEG was done for 24 hours for each infant. Amplitude-integrated EEG was interpreted by a neonatologist; video EEG was interpreted by a neurologist independently. Thirty-five infants were included in the analysis. In the 7 infants with seizures on video EEG, there were 169 seizure episodes on video EEG, of which only 57 were identified by amplitude-integrated EEG. Amplitude-integrated EEG had a sensitivity of 33.7% for individual seizure detection. Amplitude-integrated EEG had an 86% sensitivity for detection of babies with seizures; however, it was nonspecific, in that 50% of infants with seizures detected by amplitude-integrated EEG did not have true seizures by video EEG. In conclusion, our study suggests that amplitude-integrated EEG is a poor screening tool for neonatal seizures.