Swan song of the dying brain

A colleague wrote:  "What I struggle with, which I'm sure everyone else does as well, is what to do about the neonates who continue to have electrographic seizures despite both phenobarbital and fosphenytoin.   Do these children merit a midazolam drip?  Do they merit keppra?  Do they merit bumetanide?  Do you just wait for the seizures to 'burn out' as they so often do?"

 

I responded:  I tend to think of the electrographic seizures in this situation as the swan song of the dying brain. Generally, I will treat with levetiracetam, as well, but, in truth, I'm dubious of the efficacy of any further therapy in this situation. As indicated, the seizures generally "burn out" relatively soon as the brain dies.