Oral Levetiracetam as Add-On Therapy in Refractory Neonatal Seizures

Area of Science:

• Neonatal Neurology
• Pediatric Epilepsy
• Clinical Pharmacology

Background:

• Neonatal seizures are a common manifestation of neurological disorders in newborns.
• Phenobarbital and phenytoin are standard first-line treatments for neonatal seizures, following correction of metabolic derangements.
• Refractory seizures necessitate exploration of alternative therapeutic strategies.

Purpose of the Study:

• To evaluate the efficacy of oral levetiracetam as an add-on therapy for neonatal seizures.
• To compare the effectiveness of levetiracetam against traditional first-line treatments in a neonatal intensive care unit (NICU) setting.

Main Methods:

• A clinical trial enrolled neonates presenting with seizures in Qom hospitals (2015-2017).
• Patients initially received intravenous phenobarbital, followed by intravenous phenytoin if refractory.
• Oral levetiracetam was administered as add-on therapy for cases unresponsive to both phenobarbital and phenytoin.

Main Results:

• Out of 245 enrolled neonates, 12 were excluded.
• Phenobarbital was administered to 233 neonates, with 86 showing no response.
• Phenytoin was given to 86 neonates, and 42 remained refractory, subsequently treated with oral levetiracetam.
• Oral levetiracetam achieved seizure control in 95.3% of the refractory cases.

Conclusions:

• Oral levetiracetam demonstrates significant efficacy as an add-on therapy for neonatal seizures refractory to phenobarbital and phenytoin.
• This approach is particularly valuable when intravenous levetiracetam formulations are not accessible.
• Levetiracetam represents a promising option for managing difficult-to-treat neonatal epilepsy.