Levetiracetam in the treatment of neonatal seizures: A pilot study

• Published in: Seizure (London, England) Vol. 19; no. 3; pp. 185 - 189
• Main Authors: Fürwentsches, Alexandra, Bussmann, Cornelia, Ramantani, Georgia, Ebinger, Friedrich, Philippi, Heike, Pöschl, Johannes, Schubert, Susanne, Rating, Dietz, Bast, Thomas
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2010
• Subjects: Anticonvulsants - therapeutic use; Epilepsy; Feasibility Studies; Female; Humans; Infant, Newborn; Levetiracetam; Male; Neonatal seizures; Neurology; Pilot Projects; Piracetam - analogs & derivatives; Piracetam - therapeutic use; Seizures - therapy; Treatment Outcome; Neonatal seizures; Epilepsy; Levetiracetam
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2010.01.003

Abstract Purpose At present, neonatal seizures are usually treated with Phenobarbital (PB) despite the limited efficacy and the potential risk this treatment holds for the developing brain. We report here a prospective pilot feasibility study on the use of Levetiracetam as monotherapy in the treatment of neonatal seizures. Methods Six newborns (body weight > 2000 g, gestational age > 30 weeks) presenting with neonatal seizures were enrolled. Patients whose seizures were caused by electrolyte disturbances or hypoglycemia, or whose seizures did respond to pyridoxine were excluded. Patients previously treated with other antiepileptic drugs (AEDs), with the exception of single PB doses before and during titration, were excluded. LEV was administered orally, increasing the dose by 10 mg/(kg day) over 3 days. Endpoint was the need of any additional AEDs (or PB) after day 3, or 3 months of LEV treatment. A decision regarding further treatment was made on an individual basis and follow-up was documented up to 8 months of age. Results No severe adverse effects were observed. Mild sedation was reported in one infant. All six patients treated with oral LEV became seizure free within 6 days. Five patients remained seizure free after 3 months with ongoing LEV monotherapy. One infant developed pharmacoresistent epilepsy. Seizures relapsed later in the clinical course of two more patients, one of whom was no longer under LEV therapy. Discussion Results from our small patient group indicate that LEV may be an alternative therapeutic option in neonatal seizures.