DR.RAHUL ANAND YADAV MD DM(NEONATOLOGY) HOD KKCTH
When to us use? Whic ich type of se seiz izur ures? es? How much(d (dose ose of d drug) g) to us use? Ho How lo long g to us use?
MANDAN MISHRA SANKARACHA CHARY RYA
1)Eye witness 2)Logic 3)Guidelines by authority in subject
Normal Neonatal Brain Neonatal convulsions Drug Action Conclusions
Disturbed balance between excitatory and inhibitory neurotransmitters Excitatory:Glutamat e Gaba Inhibitory:Gaba Glutamate tamate
Subtle seizures Multi focal clonic Generalized tonic Myoclonic
Signal al to noise ratio SV2A 2A agonist ist • Synaptotagmin is a calcium • Depends upon levels of sensor for exocytosis in pre cytosolic calcium levels. synaptic vesicle leading to excitatory NT release into • When cytosolic calcium levels synaptic junction. are high, signal to noise ratio is altered resulting in • SV2A regulates the activity of seizures. synaptotagmin leading to inhibition of calcium mediated • Levetiracetam inhibits the exocytosis. release and influx of calcium into cytosol thereby reducing • Levetiracetam acts as an the signal to noise ratio agonist of synaptic vesicle protein 2A
Can be used in neonates Do not use in subtle and generalized tonic seizures “Use in Myocloni onic seizur ures, es, especi cial ally ly stimulus ulus sen ensi siti tive ve thalamocort mocortical ical myoclonus onus ”
“DOES NOT EXIST”
When to use? Which type of seizure to use? How much to use? How long to use?
Status NOT EPILEPSY LEVETIRACET DIAZEPAM 4 hours Epilepticu AM RISK REDUCED s
LEVETIRACETAM PHENOBARBITONE Respiratory depressant Respiratory depressant action present action absent Myocardial depressant Myocardial depressant action present action absent Metabolic Metabolic demand:? demand:Decreased Multifocal clonic Multifocal clonic seizure:useful seizure:use unknown Myocl clonic onic: less useful Myocloni clonic: c:more more useful ul Drug interact ractions ions Drug g interac acti tions ons present ent ab absent ent
Liver dysfunction Liver dysfunction absent present In instances where In instances where there is increased there is increased levels of ammonia,it is levels of ammonia,it is safe unsafe Pharmacoresistance Pharmacoresistance not seen(MDR protein) seen LEV EVETIR ETIRAC ACETA ETAM VALPR LPROAT OATE
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
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
Routinely don’t use Can be used in stimulus sensitive myoclonic convulsions Higher doses tolerated better Stop as soon as primary etiology is better
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