We report the results of treatment of intractable
seizures with
lorazepam in seven neonates. All of the patients were part of a prospective study, who failed to respond to 40 mg/k of
phenobarbital.
Lorazepam was given intravenously at 0.05 mg/k and repeated up to a total dose of 0.15 mg/k if necessary. The diagnosis of
seizures and the efficacy of treatment was assessed clinically and by EEG during the administration of
lorazepam in three patients and on clinical grounds in four patients. Six patients were full term and one was premature; there were five males and two females. Four patients had
hypoxic-ischemic encephalopathy, two had
intracranial hemorrhage, and one had
bacterial meningitis. Two patients received one dose of
lorazepam, three received two doses, and two received three doses. Six patients responded with a complete cessation of
seizures within three minutes of their last dose; the remaining patient (who received two doses) had a reduction in
seizures. No patients developed
apnea or
hypotension during or immediately after the infusion of
lorazepam and no other adverse effects were observed. Four patients remained seizure-free for the rest of the neonatal period and no other
anticonvulsant medications were added.
Seizures recurred in one patient at 16 hours; subsequent intermittent
seizures were managed with additional
phenobarbital. In another patient,
seizures recurred at 12 hours and subsequent intermittent
seizures were managed with
phenytoin. In one patient,
seizures continued with reduction of frequency and duration. We conclude that
lorazepam may be effective in the treatment of neonatal
seizures refractory to
phenobarbital and that further treatment with intravenous
phenytoin may be unnecessary under these circumstances.