Table 1.

Summary Recommendations of the ILAE Clinical Practice Guideline on treatment of neonatal seizures.^a

	Recommendation	Based on
1a	In neonates with seizures requiring ASM, phenobarbital should be the first-line ASM.	Evidence-based with moderate strength
1b	Phenobarbital should be the first-line ASM regardless of etiology (including hypoxic-ischemic encephalopathy, stroke, and hemorrhage).	Expert consensus with high level of agreement
1c	If channelopathy is the likely cause for seizures due to family history, then phenytoin or carbamazepine (sodium channel blocker) should be the first-line ASM.b	Expert consensus with moderate level of agreement
2a	In neonates with seizures not responding to first-line ASM, phenytoin or levetiracetam may be used as a second-line ASM for most etiologies (hypoxic-ischemic encephalopathy, stroke, or hemorrhage). Other possible options include midazolam or lidocaine.	Expert consensus with moderate level of agreement
2b	If channelopathy as an etiology for the seizures is suspected because of clinical or EEG features, then a sodium channel blocker should be used as a second-line ASM.b	Expert consensus with high level of agreement
2c	In neonates with cardiac disorder(s), levetiracetam may be preferred as a second-line ASM.	Expert consensus with moderate level of agreement
3	Following cessation of acute provoked seizures (electroclinical or electrographic), without evidence for neonatal onset epilepsy, antiseizure medications should be discontinued before discharge home, regardless of MRI or EEG findings.	Expert consensus with high level of agreement
4	Therapeutic hypothermia may reduce seizure burden in term neonates with hypoxic-ischemic encephalopathy. However, the impact of therapeutic hypothermia as a specific seizure therapy was not assessed.	Evidence-based with weak strength and expert consensus with high level of agreement
5	Treating neonatal seizures (including electrographic-only seizures) to achieve a lower seizure burden may be associated with improved outcome (neurodevelopment, reduction of subsequent epilepsy).	Expert consensus with moderate level of agreement
6	A trial of pyridoxine (add-on to ASM) should be attempted in neonates presenting with clinical features or EEG characteristics suggestive of vitamin B6-dependent epilepsy and neonates with seizures unresponsive to second-line ASM without an identified etiology.	Expert consensus with high level of agreement

Abbreviations: ASM, anti-seizure medication; MRI, magnetic resonance imaging.

^a Recommendations are based on a systematic review and expert-based consensus via Delphi if insufficient evidence was available.

^b May be phenytoin or carbamazepine depending on the clinical state of the neonate (critically ill or otherwise well baby) and the regional availability of ASM and monitoring of drug levels.