الفهرس 
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Abstract
Background : Neonatal seizures are abnormal, stereotyped, paroxysmal alterations in neurological functions either motor, behavioral or autonomic (Shetty, 2015). Incidence of neonatal seizures ranges from 1.5-3.5/1000 in term newborns and up to 10-130/1000 in preterm newborns (Shin et al., 2017; Monir, 2019). Phenobarbital is still considered first line anticonvulsant treatment of neonatal seizures in North America and Europe, although the need for safer and more efficacious alternatives has been recognized (Perveen et al., 2017). Some cases not responding to Phenobarbital need second-line anticonvulsant regimens which vary widely but usually involve the benzodiazepines (diazepam, clonazepam, lorazepam, and midazolam), phenytoin, paraldehyde, Levetiracetam, lidocaine, topiramate or bumetanide. Nonetheless, data from randomized controlled trials intended to support anticonvulsant drug choice are still restricted and no concrete guidelines have been created (El-Dib et al., 2017). Aim of the work : Our aim was to provide a complete summary of current literature relevant to which drug is the best as a second line anticonvulsant used to control clinical or EEG recorded neonatal seizures with no or less side effects. Materials and Methods : We searched six databases (Cochrane library, PubMed, EBSCO, Web of science, SCOPUS, OVID) the last search was in August 2020. The search was for all the published randomized controlled trials or quasi-randomized controlled clinical trials of preterm and term neonates with clinically-apparent or suspected seizures from 1st day to 28th day of life and didn’t respond to first line anticonvulsant as phenobarbital. Results : Our results revealed that phenytoin and lidocaine are to some extent has a potentially equal efficacy as second line anticonvulsants after failure of phenobarbital and there is no strong evidence to prefer the use of one drug over the other drugs. Although, we can say that lidocaine may has higher efficacy than phenytoin and levetiracetam as second line anticonvulsants as regards to the limited number of participants in the studies. Conclusion : We concluded that there is still deficient evidence data to help to say a specific drug is the best as second line anticonvulsant following failure of phenobarbital.