Published online Aug 8, 2015. doi: 10.5409/wjcp.v4.i3.45
Peer-review started: April 24, 2015
First decision: May 13, 2015
Revised: May 25, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 8, 2015
AIM: To review the clinical response to levetiracetam (LEV) in neonatal seizure management in intensive care unit.
METHODS: Medical records of neonates who received LEV from January 2009 to August 2014 were reviewed. Their demographic data, clinical characteristics, etiology, seizures, electroencephalograms, response to treatment and outcome were noted. Literature review of use of LEV in neonates were also performed via PubMed and EMBASE with keywords - “neonates”, “seizures”, “epilepsy” and “LEV” up to Sep 2014 and retrieved the publications. The response rate to LEV was compared.
RESULTS: Twelve neonates were identified during the study period. All patients received phenobarbitone loading prior to consideration of LEV. Seven (58%) and nine (75%) achieved seizure freedom 24 h and 72 h after LEV was added, both clinically and electrographically. No serious adverse effects were associated with LEV use. From the literature, there are total 144 neonates reported to have used LEV. The overall results suggested that LEV could control up to 90% of neonatal seizures.
CONCLUSION: LEV was found to be relatively safe and efficacious in treating neonatal seizures, but might not work well in the most severe hypoxic ischemic encephalopathy.
Core tip: Neonatal seizures are common, but there is lack of evidence to support use of anticonvulsants in this group of patients. Phenobarbitone remains the first line of treatment despite its limitations. The current study aims to review our experience of using levetiracetam (LEV) in management of neonatal seizures and to compare with the experience reported in the literature. We find that LEV is a relatively safe and feasible treatment option. Difficulties in performing studies were also discussed with the latest report of using bumetanide for treatment of neonatal seizures.