LAUSR

Despite the development of new antiepileptic drugs, including those aimed at treating the pediatric population, little clinical research has been focused on neonatal seizures, a large proportion of which fail to respond to treatment. Phenobarbital appears to be the antiseizure medication most often used to treat seizures in neonates. Several groups have addressed this problem, exploring mechanisms underlying neonatal seizures, so that new drugs might be developed. Most animals studies were performed using the wellknown Rice– Vannucci model of hypoxia– ischemia, performed in rats at 10– 11 days after birth, which is considered to correspond to the brain maturity of a term newborn infant.1 Recently, the group of Kai Kaila developed a new model of birth asphyxia in rats that would more closely correspond to seizures occurring in human neonates after complex and prolonged birth and delivery.2 In a second step, the same group, in association with Wolfgang Löscher, used this model to test the efficacy of various drugs for treating seizures3; They reported that midazolam attenuated neonatal seizures when given both before and after birth asphyxia, while phenobarbital was only effective when administered before the insult. Bumetanide alone or in combination with phenobarbital was ineffective.3 These data were challenged by BenAri and Delpire,4 who wrote a commentary regarding these data, to which Kaila and Löscher responded.5 The present group of papers further discusses the treatment of neonatal seizures. The discussion begins with a commentary by Kevin Staley in which he reviews bumetanide's mechanism of action and discusses its lack of efficacy in animal models.6 Drs Kaila and Löscher then respond to Dr Staley's comments, developing arguments on why bumetanide is inactive for seizures induced by birth asphyxia in animal models.7 The commentary by Drs Pressler and Boylan focuses on clinical aspects of neonatal seizures and their treatment.8 This series concludes with comments by Stéphane Auvin on the difficulty of translating data from animal studies to humans and vice versa.9