Update on Levetiracetam in Infants and Children

Marcia L. Buck, PharmD, FCCP, FPPAG, BCPPS


Pediatr Pharm. 2018;24(7) 

In This Article

Frequency of Use

In a 2017 paper in Pediatric Neurology, Shellhaas and colleagues analyzed the choice of initial AED in a cohort of 495 newly diagnosed patients from 17 major pediatric epilepsy centers from across the United States.[2] The authors found that levetiracetam was by far the most commonly prescribed AED, regardless of epilepsy type or patient age. Two hundred ninety-one of the 464 patients (63%) initially received levetiracetam as monotherapy, followed by oxcarbazepine (14%), phenobarbital (12%), topiramate (3.4%), and zonisamide (2.8%). Of the children who did not receive levetiracetam initially, 62% were given it as their second AED. Ninety of the 163 patients (55%) diagnosed at less than 6 months of age were treated with levetiracetam as their first AED. Phenobarbital, the traditional agent of choice for neonatal seizures, was prescribed as initial therapy in only 30.7%. The authors suggest this change in practice may reflect both the increasing acceptance of levetiracetam use in the pediatric population and concerns for the potential adverse effects of phenobarbital in the developing brain.