Efficacy of levetiracetam in premature infants: our experience and review of the literature

Özalkaya, Elif; Topçuoğlu, Sevilay; Karatepe, Hande Özgün; Tüten, Abdülhamit; Gökmen, Tülin; Karatekın, Güner

doi:10.1080/14767058.2018.1481946

Cited by 5 publications

(22 citation statements)

References 17 publications

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“…Similar with the Kurthom et al study population, our study included only extremely preterm infants. In contrast to the results of Kurthom et al [4] and Özelkaya et al [15] studies, we determined that seizure control was achieved in 60% of all patients, and the rate of seizure control increased to 67% when LEV was first-line treatment. Unfortunately, we could not obtain statistically significant differences between the firstline therapy group and second or third-line therapy groups in terms of the rate of seizures management.…”

Section: Discussioncontrasting

confidence: 87%

“…Neonatal seizures should be monitored and treated carefully to avoid brain damage [1,5,7]. In premature babies, treatment of neonatal seizures quickly and choosing the drug with the least side effects at treatment and follow up are much more important than it is for full-term neonates in terms of long-term neurodevelopmental outcomes [7,9,15]. Also, the frequency of NEC is higher in prematures and they may not be able to take oral medicines for a long time.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, some studies in the literature show that using LEV in premature infant seizures is effective and safe for neonates [2,9]. However, studies about the use of LEV in extremely preterm infants with seizures is limited with only a handful studies, the results of which highly vary [4,9,15]. Han et al [9] conducted a retrospective analysis of 37 preterm infants (mean gestational age 31.5±1.9 weeks (range, 26 to 36+6 weeks)) who were treated with LEV as the first-line anti-seizure medication.…”

Section: Discussionmentioning

confidence: 99%

“…In their cohort, 57% of all preterm infants were seizure-free while on LEV at the end of the first week, no additional anti-seizure medication was required and they suggested that LEV can be an acceptable and safe choice for treatment of neonatal seizures in preterm infants [9]. Özelkaya et al [15] retrospectively evaluated 26 preterm infants, including extremely preterm infants (the mean gestational was 26.7±3.3 weeks) treated with LEV. No side effects were observed during LEV treatment.…”

Section: Discussionmentioning

confidence: 99%

“…However, data about efficacy and safety of using LEV in even preterm infants is limited, data about using LEV in extremely preterm infants with seizures is even more insufficient and is limited to only a handful studies [4,9,15]. This study aims to evaluate the efficacy and safety of LEV in the treatment of seizures in extremely preterm infants.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the efficacy and safety of levetiracetam treatment for neonatal seizures in extremely preterm infants

Mert¹,

Orgun²

2020

Journal of Surgery and Medicine

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Ethics Committee Approval: This study was approved by the Ethics Committee of Çukurova University Medicine Faculty (2019/89). All procedures in this study involving human participants were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Etik Kurul Onayı: Bu çalışma Çukurova Üniversitesi Tıp Fakültesi Etik Kurulu tarafından onaylandı (2019/89). İnsan katılımcıların katıldığı çalışmalardaki tüm prosedürler, 1964 Helsinki Deklarasyonu ve daha sonra yapılan değişiklikler uyarınca gerçekleştirilmiştir.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of the efficacy and safety of levetiracetam treatment for neonatal seizures in extremely preterm infants

Mert¹,

Orgun²

2020

Journal of Surgery and Medicine

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Levetiracetam as the first‐line treatment for neonatal seizures: a systematic review and meta‐analysis

Hooper

Ramaswamy

Wahid

et al. 2021

Develop Med Child Neuro

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Aim To assess the effectiveness and safety of levetiracetam when used as first‐line treatment of neonatal seizures. Method Four electronic databases, Medline, Embase, Web of Science, and ClinicalTrials.gov were systematically searched from inception until 20th November 2020. Randomized controlled trials (RCTs) and observational studies that included neonates born preterm and term were eligible for inclusion. The primary outcome measure was levetiracetam effectiveness, defined as seizure cessation within 24 hours of starting treatment. Secondary outcomes included short‐term adverse events, mortality before discharge, and long‐term neurodevelopmental outcomes. Results Fourteen studies assessing 1188 neonates were included: four RCTs, three observational trials with phenobarbital as the control arm, and seven observational studies of levetiracetam with no control arm. Pooled efficacy of levetiracetam from observational studies was 45% (95% confidence interval [CI] 34–57%) (GRADE – very low). Meta‐analysis of RCTs evaluating levetiracetam versus phenobarbital showed that both were equally effective (risk ratio [95% CI] 0.6 [0.30–1.20]) (GRADE – very low). Levetiracetam resulted in a lower risk of short‐term adverse events compared to phenobarbital (risk ratio [95% CI] 0.24 [0.06–0.92]) (GRADE – moderate). Interpretation Very low certainty of evidence suggests levetiracetam might not be more effective than phenobarbital. Moderate certainty of evidence indicates levetiracetam is associated with a lower risk of adverse events. Future trials on neonatal antiseizure medication therapy should include continuous electroencephalogram (EEG) monitoring as standard of care and enrol a homogenous population with similar seizure aetiology. Levetiracetam is effective in 45% of neonatal seizures. Levetiracetam might not be more effective than phenobarbital. Levetiracetam is likely to be safer than phenobarbital. Evidence available is limited and of very low certainty.

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Efficacy and Safety of Levetiracetam vs. Phenobarbital for Neonatal Seizures: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Neonatal seizures are a common neurological emergency in newborns. Phenobarbital (PB) is the first-line antiepileptic drug (AED). However, PB has some side effects, such as hypotension and respiratory depression, and it can accelerate neuronal apoptosis in the immature brain. Levetiracetam (LEV), a new antiepileptic drug, has been used as a second-line drug for the treatment of neonatal seizures. Compared with PB, LEV has many advantages, including a low incidence of side effects and better neurodevelopmental outcomes. However, there are only a few systematic reviews of LEV for the treatment of neonatal seizures.Objective: To evaluate the efficacy and safety of LEV for neonatal seizures and to compare the efficacy, side effects, and neurological outcomes between LEV and PB in the treatment of neonatal seizures.Methods: The keywords LEV, PB, and neonatal seizure were searched in the MEDLINE, Cochrane Library, Web of Science, EMBASE, clinicaltrials.gov, and China National Knowledge Internet (CNKI) databases with a last update in July 2021 to collect high-quality studies. We collected studies studying the efficacy or safety of LEV and PB in the treatment of neonatal seizures applying strict inclusion and exclusion criteria. The data were extracted and outcome measures, including efficacy, side effect rate, neurological score, and mortality rate, were analyzed with RevMan 5.3 software.Results: Ten articles were finally included in the meta-analysis. The meta-analysis showed that there was no difference in efficacy between LEV and PB in the treatment of neonatal seizures. Compared with PB, the incidence of side effects of LEV was lower. The incidence of hypotension and respiratory depression in the LEV group was significantly lower than that in the PB group. In terms of long-term neurodevelopmental outcomes, there was no significant difference in the Bayley Scales of Infant Development (BSID) scores between LEV and PB.Conclusion: PB is still the first-line AED recommended by the WHO for the treatment of neonatal seizures. The new AEDs LEV may not have better efficacy than PB. At the same time, LEV is associated with better neurodevelopment outcomes and a lower risk of adverse effects. In addition, continuous EEG monitoring should be used to diagnose neonatal seizures to evaluate the severity of the seizures, remission, and drug efficacy.Systematic Review Registration: PROSPERO, identifier: CRD42021279029.

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Efficacy of levetiracetam in premature infants: our experience and review of the literature

Abstract: Seizure control was better achieved with LEV given as the 2nd antiepileptic in premature infants. Further studies with randomization of LEV and other antiepileptics in seizure control are needed.

Cited by 5 publications

References 17 publications

Evaluation of the efficacy and safety of levetiracetam treatment for neonatal seizures in extremely preterm infants

Evaluation of the efficacy and safety of levetiracetam treatment for neonatal seizures in extremely preterm infants

Levetiracetam as the first‐line treatment for neonatal seizures: a systematic review and meta‐analysis

Efficacy and Safety of Levetiracetam vs. Phenobarbital for Neonatal Seizures: A Systematic Review and Meta-Analysis

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