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

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.

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