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Withdrawal of anticonvulsant drugs in HIE


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In a case with with stage 2 { moderate } Hypoxic ischemic encephalopathy (HIE) and seizures in 1 st day of life controlled by Phenobarbital , Phenytion and Midazolam.

How and when should these drugs be withdrawed?


Mohamad Ismail

neonatology resident



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In case seizures do not recur, i withdraw znticonvulsants before hospital discharge, depending on duration of hie and neurological examination.if hie gr2 lasts less than 5 days and neonates are well, i withdraw aed if ultrasond skull and neonatal neurological examination are normal.in case of abnormality in cranial ultrsond or neuro examination, i continye aed for 3 months, get an eeg done if normal aed are tapered. in case of abnormality of neuro examination/mri aed are further continued.

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I would suggest that you start to wirhdraw phenytoin. If the baby is free from seizures, then wean off midazolam. If also phenobarb Should be stopped, depends on the clinical scenario as a whole and What the EEG looks like.

We commonly " auto-wean" phenobarb , i.e. Keep the dose as such for 3-6 months, with no weight corrections as the baby grows.

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i think a normal eeg at one month age is the best guide for early withdrawal or seizure free period of first nine months and weaning first one drug then second so on. outoweanig is new to to me and makes a lot of sense thanks stefan

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