We often represent parents of a child seriously injured during birth. Any time a newborn child has health problems, it can be frightening and overwhelming for the parents. This may be especially true when a newborn suffers from seizures. This unfortunate situation is only compounded by the fact that anti-seizure medications which are often effective in adults, and even children, can have little to no effect when used on infants.
In fact, research paid for by the National Institute of Neurological Disorders and Stroke (NINDS) has not only confirmed this disparity in effectiveness, but helped to explain it. And the good news is that this same research offers a simple suggestion for a more effective treatment for these littlest seizure victims.
By far the most common anti-seizure treatment used in newborns is phenobarbital, a commonly-used anti-seizure medication in adults. But when phenobarbital is administered to a newborn, it does not eliminate seizure activity in the cortex (the outer layer of the human brain, which is responsible for higher-level control).
What phenobarbital does do in infants is eliminate the evidence of seizures. The hallmark convulsions stop, leading parents to believe that the treatment their physician has prescribed is working, when in fact it is not.
This phenomenon is known as electroclinical uncoupling. Once phenobarbital is administered and the convulsions have been quieted, the seizures can only be identified through the use of an EEG (electroencephalography), where electrodes are placed on a victim’s scalp to measure cortex activity.
Infants treated with phenobarbital are thus in grave danger. Seizure activity in the cortex can lead to serious brain injury, which in turn can lead to permanent injury, life-long disability, and even death. In fact, experts believe that infant seizures are responsible for a not-insignificant percentage of the victims of such conditions as cerebral palsy, epilepsy and other cognitive disabilities. But these parents believe that their child is no longer in danger, when in fact the seizure activity is ongoing.
In fact, research performed over the past few years indicated that the effects of phenobarbital may be even worse than previously thought. This research indicates that the drug works by mimicking GABA, a brain chemical which inhibits mature neurons and thus slows or stops seizures, caused by the hyperactivity of neurons in the brain. But GABA has the opposite effect on immature neurons – activating rather than inhibiting.
Researchers believe that neurons deep in the brain (which control the muscles involved in convulsions during seizures) mature faster than those in the cortex. Thus, phenobarbital stills these mature neurons, stopping convulsions, but may actually be exacerbating the seizure activity in the cortex, increasing the likelihood of life-altering or ending brain injury.
Those knowledgeable on infant brain injury thus believe that prescribing phenobarbital alone for infant seizures amounts to medical malpractice. Yet, in spite of the information now available, many physicians continue to prescribe this misleading drug.
Help is on the way. Informed doctors now know that the simple expedient of using phenobarbital in combination with another drug can completely stop seizures, even in infants. Bumetanide, commonly prescribed to adults as a diuretic (and used to treat heart disease and kidney disease in infants and newborns) can block NKCCI, a protein which causes chloride into neurons. This lower chloride level causes immature neurons to mimic mature neurons, and allows phenobarbital to stop seizures at all levels of the brain, even in newborns.
This drug combination is now in clinical trials, and will hopefully be approved soon. In the meantime, parents with newborns suffering from seizures should actively question any physician who attempts to prescribe phenobarbital alone as a treatment.
Moreover, if your newborn suffered seizures, was treated with phenobarbital, and subsequently developed a condition such as cerebral palsy, talk to an experienced brain injury attorney about your circumstances. You may have a case against the prescribing physician for his negligent treatment of your newborn.
Stephen M. Passen has over 30 years experience representing families in difficult birth injury malpractice actions. For a free consultation with an experienced Chicago birth injury lawyer at Passen Law Group, call us at (312) 527-4500.