Levetiracetam as First-Line Anti-seizure Medicine in Electrographically Confirmed Neonatal Seizures: A Literature...

Area of Science:

• Neonatal Neurology
• Pharmacology
• Evidence-Based Medicine

Background:

• Phenobarbitone (PHB) is the standard first-line anti-seizure medicine (ASM) for neonatal seizures (NS).
• PHB's side effect profile poses challenges, particularly in low-to-middle-income countries (LMICs) with limited monitoring facilities.
• Levetiracetam (LEV) is an emerging ASM for NS with a favorable short-term safety profile.

Purpose of the Study:

• To evaluate Levetiracetam (LEV) as a first-line anti-seizure medicine (ASM) for neonatal seizures (NS).
• To compare the efficacy and safety of LEV with Phenobarbitone (PHB) and assess LEV used alone.

Main Methods:

• Comprehensive literature search across multiple databases (PubMed, Medline, Cochrane, etc.).
• Inclusion of five retrospective observational studies meeting strict criteria.
• Quality assessment using Critical Appraisal Tool Program (CASP) and risk of bias assessment using Newcastle-Ottawa Scale (NOS).

Main Results:

• All included studies exhibited moderate to high risk of bias.
• LEV may be equally effective and safer than PHB.
• LEV appears effective in neonates with low seizure burden when used without comparison.

Conclusions:

• Current evidence suggests LEV is a potential alternative to PHB for neonatal seizures (NS).
• The poor quality of existing evidence prevents recommendation as a first-line ASM.
• High-quality randomized controlled trials, particularly from LMICs, are urgently required.