Professor of pediatrics; Charles Frost Chair in Neurosurgery and Neurology; director, The Saul R. Korey Departments of Neurology Clinical Neurophysiology and Pediatric Neurology, Albert Einstein College of Medicine, Montefiore Medical Center

Solomon Moshe, MD

"There’s little evidence in the literature to support treatment with any 1 anti-seizure medication. We have very limited randomized controlled trials that look at neonatal anti-seizure medications. There’s no standard way that everyone treats and there’s no first-line medication that everyone uses.”

Researchers from the Neonatal Seizures Task Force, a group established by the International League Against Epilepsy (ILAE), recently published a position paper on a modification to the 2017 ILAE Classification of Seizures and Epilepsies. The report addressed a number of issues and ways to ultimately eliminate misdiagnosis of seizures in the neonatal stage, emphasizing the use of electroencephalography (EEG), as well as including a classification of seizure types relevant to this group.

Despite the recent advances in understanding and diagnosing neonatal seizures, there is still more work to be done, according to Solomon Moshe, MD, and Elissa Yozawitz, MD. Moshe, ILAE past president and current Charles Frost Chair in Neurosurgery, and Yozawitz, director of Neonatal Neurology, both at 

They claim there still needs to be more research on anti-seizure medications within this age group, but that the complexities of conducting clinical trials have protruded. In an interview with 

the duo discussed aspects from their recommendations that weren’t mentioned in the new modifications that need addressing.

Pressler RM, Cilio MR, Mizrahi EM, et al. The ILAE classification of seizures and the epilepsies: modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures. 

 Published February 1, 2021. doi: 10.1111/epi.16815

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The duo from Montefiore Medical Center discussed aspects of their recently published recommendations on neonatal seizure diagnosis that need further examining. 

Future Aspirations of Neonatal Seizure Research: Solomon Moshe, MD; Elissa Yozawitz, MD

"For the more subtle types of seizures, we really need that EEG to determine whether it’s a seizure or not.”

Misdiagnosing different types of seizures in the neonatal stage can have significant consequences for a newborn, especially if they are then put on disease-modifying therapies (DMTs). These seizures can occur with clinical manifestations or without clinical manifestations, therefore increasing the need to standardize the use of electroencephalography (EEG) use to evaluate and correctly diagnose this patient group.

A recently published modification of the 2017 International League Against Epilepsy (ILAE) Classification of Seizures and Epilepsies, did just that. A Neonatal Seizures Task Force that comprised of international epilepsy specialists called for the emphasis of EEG in the diagnosis and included a classification of seizures types relevant to this age group. ILAE past president Solomon Moshe, MD, and Elissa Yozawitz, MD, were among those involved with the task force.

Moshe, Charles Frost Chair in Neurosurgery and Neurology, and Yozawitz, director of Neonatal Neurology, both at Montefiore Medical Center, sat down with 

to discuss ways to improve misdiagnosis rates in the neonatal stage.

The duo from Montefiore Medical Center detailed the reasons why EEGs must remain an interictal part in improving rates of misdiagnosing neonatal seizures. 

Ways to Lower Misdiagnosis Rates of Neonatal Seizures: Solomon Moshe, MD; Elissa Yozawitz, MD

"By understanding it and linking it to the EEG, clinicians will have a better visual representation of what the seizure types. The clinical observation and widespread availability of EEG has helped.”

For 8 years, pediatric neurologists around the world have been working together to create recommendations specifically for newborns who present with seizures. In February 2021, the International League Against Epilepsy (ILAE) published a modification to the 2017 ILAE Classification of Seizures and Epilepsies which emphasized the role of electroencephalography (EEG) diagnosis of seizures in the neonate and includes a classification of seizure types relevant to this age group.

ILAE notes in its published report that seizures can occur with or without clinical manifestations, and that descriptors are determined by the predominant clinical feature and divided into motor, non-motor, and sequential. ILAE past president Solomon, L. Moshe, MD, Charles Frost Chair in Neurosurgery and Neurology, and Elissa Yozawitz, MD, director of Neonatal Neurology, both at 

the duo detailed the role technology played into making these modifications, and how it can continue to improve overall diagnosis and clinical care for newborns with seizures.

The duo from Montefiore Medical Center discussed how the advancement of technology has benefitted diagnosing epilepsy and classifying seizures in newborns.

Technology in Diagnosing Epilepsy, Seizures in Newborns: Solomon Moshe, MD; Elissa Yozawitz, MD

"As we moved along, we realized that newborns represented a different group of patients because most of the seizures will appear as the patient is sleepy or even ‘comatose’ because they have suffered some type of hypoxia ischemia.”

In early February 2021, researchers from the Neonatal Seizures Task Force, a group established by the International League Against Epilepsy (ILAE), published a position paper on a modification to the 2017 ILAE Classification of Seizures and Epilepsies. In summary, they call for an emphasis on the use of electroencephalography (EEG) in the diagnosis of seizures in the neonate, as well as including a classification of seizure types relevant to this age group.

They also describe how many neonatal seizures are electrographic, only with no evident clinical features, therefore, they should be included in a newly proposed classification. Additionally, clinical events without an electroencephalogram (EEG) correlate were not included in the modifications.

ILAE past president Solomon, L. Moshe, MD, Charles Frost Chair in Neurosurgery and Neurology, and Elissa Yozawitz, MD, director of Neonatal Neurology, both at 

, were part of the task force. They sat down with 

to discuss how these revisions came about, and the significance they have on clinical care.

Published February 1, 2021. doi: 10.1111/epi.16815

The duo from Montefiore Medical Center discussed new modifications to the 2017 International League Against Epilepsy (ILAE) classification of seizures and epilepsies, relevant to neonates.

Solomon Moshe, MD

Articles

Future Aspirations of Neonatal Seizure Research: Solomon Moshe, MD; Elissa Yozawitz, MD

Ways to Lower Misdiagnosis Rates of Neonatal Seizures: Solomon Moshe, MD; Elissa Yozawitz, MD

Technology in Diagnosing Epilepsy, Seizures in Newborns: Solomon Moshe, MD; Elissa Yozawitz, MD

Revisions to ILAE Classification of Seizures and Epilepsies: Solomon Moshe, MD; Elissa Yozawitz, MD