Is Levetiracetam an Effective First-line Treatment for Neonatal Seizures?

Pavankumar Kamat

Disclosures

July 01, 2021

Takeaway

  • Levetiracetam may not be more effective than phenobarbital in achieving seizure cessation when used as the first-line treatment for neonatal seizures.

  • However, levetiracetam had a better short-term safety profile than phenobarbital.

Why this matters

  • Findings suggest that seizure aetiology and continuous electroencephalogram monitoring should be considered while planning future trials on antiseizure medications.

Study design

  • UK researchers conducted a meta-analysis of 14 studies (4 randomised controlled trials [RCTs]; 10 observational trials) including 1188 neonates.

  • Primary outcome: seizure cessation within 24 hours of levetiracetam administration.

  • Secondary outcomes: short-term adverse events, mortality before discharge and long-term neurodevelopmental outcomes.

  • Funding: None.

Key results

  • Pooled results of observational trials showed that 45% (95% CI, 34-57%) of neonates responded to levetiracetam when used as a first-line antiseizure treatment.

  • Pooled results of RCTs showed that levetiracetam and phenobarbital were equally effective in achieving seizure control (risk ratio [RR], 0.60; 95% CI, 0.30-1.20; I2, 93%).

  • Levetiracetam vs phenobarbital was associated with a lower risk of short-term adverse events (3 RCTs; RR, 0.24; 95% CI, 0.06-0.92; I2, 69%).

  • No significant differences were seen between levetiracetam and phenobarbital groups in (RR; 95% CI):

    • mortality before discharge (4 RCTs; 0.82; 0.41-1.63); and

    • long-term neurodevelopmental outcomes (2 RCTs; 0.68; 0.08-6.01).

Limitations

  • Heterogeneity among studies.

 

Hooper RG, Ramaswamy VV, Wahid RM, Satodia P, Bhulani A. Levetiracetam as the first-line treatment for neonatal seizures: a systematic review and meta-analysis. Dev Med Child Neurol. 2021 Jun 13 [Epub ahead of print]. doi: 10.1111/dmcn.14943. PMID: 34124790.  View abstract .

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....