UP-DATE ON THE SUBJECT OF NEONATAL CONVULSIONS [Attualità in tema di convulsioni neonatali]

New experimental, clinical and therapeutic results in the field of convulsive disorders of the newborn have recently come to light. Experimental studies on animals have shown that, contrary to what was assumed in the past, the immature brain is highly excitable, and during the first weeks of life excitation processes predominate over inhibitory processes. Over the last ten years, benign idiopathic convulsions in newborns, familial convulsions and benign convulsions on the fifth day of life, have been defined. Both types develop and disappear spontaneously during the first week of life and have a favourable prognosis, although they may appear at the start (especially the benign fifth-day convulsions) as status epilepticus. Recently, two types of convulsive status epilepticus in newborns have been identified: a severe idiopathic status epilepticus and focal status epilepticus. The myoclonic syndromes which occur during quiet sleep and which are not accompanied by EEG discharges should be distinguished from convulsions and do not require anti-convulsive therapy. The various EEG monitoring techniques have shown an unexpectedly high number of convulsions, especially in the form of sub-clinical convulsions and/or atypical convulsive seizures. The atypical seizures distinctly predominate in status epilepticus. The clinical evidence of the seizures in reduced by administration of anti-convulsants, which seem to block typical seizures and, viceversa, to be less active for atypical seizures and EEG seizures. In the therapeutic field, the use of phenobarbital and/or phenytoin at a high initial dosage (20 mg/kg) has been well affirmed. Drugs such as lidocaine and thiopental are currently being