Cia Sharpe FRACP

Improving the management of seizures in at risk neonates

I did my advanced training in paed neurology at UCSD in San Diego. During the clinical training there I became interested in the detection and treatment of neonatal seizures. When intravenous levetiracetam became available we began working towards an RCT of Levetiracetam for the treatment of neonatal seizures. After my clinical residency was completed I did a research fellowship in neonatal and developmental neurology at UCSD, mainly working on a pharmacokinetic study of intravenous levetiracetam in the neonatal age group- necessary ground work for the NIH application for the RCT. I returned to New Zealand when a clinical position became available at Starship Hospital Auckland in 2007 and continued working on the pharmacokinetic study, establishing Auckland as a further study site. Once the pharmacokinetic study was complete we began applying for funding for the RCT. We were eventually successful in obtaining FDA funding for this study which began recruitment in late 2013 at five Californian hospitals and in Auckland.

Interview by Russell Dale


What is your primary research aim at the moment?

There are two studies in the NEOLEV2 study. The primary aim is to study the efficacy of levetiracetam versus phenobarbital in the treatment of neonatal seizures. We are also studying the feasibility of continuous full neonatal montage EEG monitoring in at risk neonates using remote centralised review via the internet and simultaneously evaluating in real time the sensitivity and specificity of Persyst’s automated neonatal seizure detection algorithm.


What excites you most about your current research project?

It’s a very easy sell to recruit to this study reflecting that we are soooo far from offering what should be the gold standard of care in EEG monitoring for at risk neonates and that our current standard of care treatments are ancient toxic drugs that only work 45% of the time. It is exciting after eight years of preliminary studies, grant applications and paperwork to be actually up and running and hopefully moving towards better detection and treatment options. Its pretty exhausting though, so I’m actually only intermittently excited about it!!!


What is the biggest barrier to fulfilling your research aims?

Under-funding and fatigue.


What do you think could be the most achievable multi-centre research project in ANZCNS?

Aha! Funny you should ask Russell, I think we need some evidence base behind our management of presumed autoimmune encephalitis, antibody positive or negative. We should do an observational study of what is already happening around Australasia and then put our heads together and work towards an RCT.
There is also huge scope for further studies in neonatal seizure management also, but harder to achieve possibly given resource issues.


What is your favourite place to go in North Island NZ?

New favourite has to be Tapapakanga Regional Park.