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Published on: May 16, 2019
Association between anti-seizure medication and outcomes in infants
Elizabeth K Sewell1, Shannon E G Hamrick2, Ravi M Patel2
1Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, USA. elizabeth.sewell@emory.edu.
Insights
Phenobarbital is more effective than levetiracetam for first-line treatment of neonatal seizures, showing lower treatment failure rates. Second-line treatment failure rates did not differ significantly between phenytoin and levetiracetam.
Area of Science:
- Neonatal Neurology
- Pharmacology
- Clinical Pediatrics
Background:
- Neonatal seizures require prompt and effective anti-seizure medication (ASM).
- Phenobarbital and levetiracetam are commonly used first-line treatments, with phenytoin used as a second-line option after phenobarbital failure.
Purpose of the Study:
- To compare treatment failure rates between phenobarbital and levetiracetam as first-line therapy for neonatal seizures.
- To compare treatment failure rates between phenytoin and levetiracetam as second-line therapy following phenobarbital treatment.
Main Methods:
- Retrospective cohort study of 6842 infants with neonatal seizures.
- Treatment failure defined as requiring additional ASMs within 24-72 hours.
- Mixed-effect logistic regression analysis adjusted for confounding factors.
Main Results:
- First-line phenobarbital (31% failure) showed lower treatment failure than levetiracetam (38% failure) (aOR 0.70; 95% CI 0.58-0.84).
- No significant difference in second-line treatment failure between phenytoin and levetiracetam (aOR 1.31; 95% CI 0.92-1.86).
Conclusions:
- Phenobarbital is associated with a lower treatment failure rate compared to levetiracetam for initial neonatal seizure management.
- Levetiracetam and phenytoin demonstrate comparable treatment failure rates when used as second-line therapy after phenobarbital.
Objective:
To compare treatment failure between: (1) infants treated with phenobarbital versus levetiracetam for first-line treatment and (2) infants treated with phenytoin versus levetiracetam for second-line treatment following phenobarbital.
Study Design:
This retrospective cohort study included infants with seizures receiving phenobarbital or levetiracetam as the initial anti-seizure medication. Treatment failure was defined as the need for additional anti-seizure medication within 24-72 h and compared using mixed-effect logistic regression after adjustment for confounding factors, including center.
Results:
In this cohort of 6842 infants, the incidence of treatment failure was 31% vs. 38% in infants receiving first-line phenobarbital versus levetiracetam (adjusted OR: 0.70; 95% CI 0.58-0.84). There was no significant difference in second-line treatment failure (adjusted OR: 1.31; 95% CI 0.92-1.86).
Conclusions:
First-line treatment of neonatal seizures with phenobarbital is associated with a lower rate of treatment failure than levetiracetam. There was no significant difference in second-line treatment failure.
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