cessation of clinical seizures must be followed by an EEG looking for
clinically silent electroencephalographic seizures because clinically
silent seizures produce significant oxygenation changes in the brain.
electroencephalographic seizures are present, our current approach is
to maintain phenobarbital and phosphenytoin levels in a high therapeutic
range and to use lorazepan intermittently to stop the long electroencephalographic
seizures. In a published report phenobarbital did not stop seizures in
57% of neonates, phenytoin did not stop seizures in 55% of neonates, and
when used simultaneously, they did not stop seizures in 40% of neonates.
Eighty percent reduction in seizure frequency was not achieved in about
25% of neonates despite the combination of phenobarbital and phenytoin.