Efficacy of levetiracetam as first-line therapy for neonatal clinical seizures and neurodevelopmental outcome at 12 months of age

Kanmaz, Seda; Köroğlu, Özge Altun; Terek, Demet; Serin, Hepsen Mine; Şimşek, Erdem; Cetin, I.; Yılmaz, Sanem; Yalaz, Mehmet; Aktan, Gül; Akısü, Mete; Kültürsay, Nilgün; Gökben, Sarenur; Tekgül, Hasan

doi:10.1007/s13760-020-01366-7

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…Therefore, we evaluated the efficacy and safety of LEV for neonatal seizures and performed a meta-analysis to evaluate the efficacy and safety of LEV vs. PB for neonatal seizures. We evaluated 24 studies (see Table 8) on LEV for the treatment of neonatal seizures, including 15 retrospective studies (7,8,21,22,31,32,35,(37)(38)(39)(40)(41)(42)(43)(44), 6 prospective studies (29,30,33,34,36), and 3 RCTs (3,24,25). In these studies, the dosage of LEV was mostly between 10 and 60 mg/kg/d.…”

Section: Summary Of the Main Resultsmentioning

confidence: 99%

“…We evaluated 24 studies (see Table 8 ) on LEV for the treatment of neonatal seizures, including 15 retrospective studies ( 7 , 8 , 21 , 22 , 31 , 32 , 35 , 37 – 44 ), 6 prospective studies ( 29 , 30 , 33 , 34 , 36 ), and 3 RCTs ( 3 , 24 , 25 ). In these studies, the dosage of LEV was mostly between 10 and 60 mg/kg/d.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, the dosage of LEV was mostly between 10 and 60 mg/kg/d. Thirteen studies used electrical seizures as the diagnostic criteria for newborns ( 3 , 7 , 8 , 21 , 24 , 30 – 32 , 34 , 37 , 38 , 41 , 43 ), 5 studies used clinical or electrical seizures as the diagnostic criteria ( 22 , 29 , 35 , 39 , 40 ), and 6 studies confirmed seizures only by clinical manifestations ( 23 , 25 , 33 , 36 , 42 , 44 ). Nine studies defined seizure cessation on EEG within 24 h as a primary outcome ( 3 , 8 , 24 , 25 , 31 , 32 , 34 , 37 , 39 ), some studies contained longer seizure control times (48 h−7 d) ( 29 , 30 , 33 , 38 , 44 ), and 7 articles did not describe the seizure control times ( 21 , 22 , 35 , 36 , 40 , 41 , 43 ).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Summary Of the Main Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…Term yenidoğanlarda ilk tedavi seçeneği olarak fenobarbital ve levatirasetam kullanılan gruplarda, 18-24 ayda, benzer nörolojik gelişimsel sonuçlar olduğu bildirilmiştir (17). Term ve preterm yenidoğan konvülziyonlarının tedavisinde ilk basamak olarak levetirasetamın kullanılması güvenli ve etkili bulunurken aynı zamanda birinci yıldaki nörolojik izlem sonuçlarının da olumlu olduğu görülmüştür (18). Ayrıca levatirasetamın ikinci basamak konvülziyon tedavisinde kullanıldığı term ve preterm bebeklerin incelendiği bir çalışmada da, levatirasetamın fenobarbitale yanıtsız hastalarda etkili olduğu gösterilmiştir (19).…”

Section: Discussionunclassified

Etiology, Clinic and Prognosis of Seizures in Preterm and Term Neonates: A Retrospective Study

Çakır¹,

Toker²,

Köksal³

et al. 2021

jcp

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Giriş: Konvülziyon yenidoğan yoğun bakım ünitelerinde (YDYBÜ) en sık görülen nörolojik sorunlardandır. Sıklığı ve etiyolojisi preterm ve term bebeklerde farklılık göstermektedir. Bu çalışma ile term ve preterm bebeklerde neonatal konvülziyonların özellikleri, nedenleri, tedaviye yanıtı ve prognozu etkileyen faktörlerin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışma retrospektif olarak 01/01/2014-01/09/2019 yılları arasında YDYBÜ'de yatarken neonatal konvülziyon tanısı almış olan veya neonatal konvülziyon tanısıyla YDYBÜ'ne yatırılan preterm ve term hastaların dosya verileri alınarak yapıldı. Nörolojik prognoz göstergesi olarak kaba motor fonksiyon sınıflaması, işitme testi sonuçları, epilepsi oranlarına bakılmıştır. Bulgular: Çalışmaya neonatal konvülziyon tanısı alan 43 preterm, 43 term bebek olmak üzere toplam 86 hasta alındı. Term hastalarda hipoksik iskemik ensefalopati (HİE) (%35), preterm bebeklerde intraventriküler hemoraji (İVH) (%54) en sık etiyolojik faktördü. Preterm bebeklerde subtle, term bebeklerde klonik nöbetler daha sıktı. Konvülziyon başlama zamanı term bebeklerde ilk gün ve 4-7 gün arasında, preterm bebeklerde ise yedi günden sonrası daha fazlaydı (p<0,05). Preterm bebeklerde İVH'ye bağlı konvülziyonlar yedi günden sonra, HİE'ye bağlı olanlar ilk gün daha yüksekti (p<0,05). Status epileptikus, pretermler bebeklerde (%30) term bebeklerden (%9,3) daha fazlaydı (p=0,015). İlk tercih antikonvülzan olan fenobarbital tedavisine yanıt term bebeklerde %71, preterm bebeklerde ise %50 idi (p=0,06). Çalışmamızda alınan kriterlere (ölüm, epilepsi, işitme kaybı, otizm ve kaba motor fonksiyon skalası >2) göre kötü prognoz oranları term bebeklerde %52 (n=16) ve preterm bebeklerde ise %75'dir (n=22) (p=0,051). Sonuç: Neonatal konvülziyon etiyolojisinde preterm bebeklerde İVH, term bebeklerde ise HİE ilk sırada bulunmuştur. Yenidoğan döneminde konvülziyon geçiren hastaların nörolojik gelişimlerinin yakın takip edilmesi gerekmektedir.

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“…Thirteen studies used electrical seizures as the diagnostic criteria for newborns (3, 7, 8, 21, 24, 30-32, 34, 37, 38, 41, 43), 5 studies used clinical or electrical seizures as the diagnostic criteria (22,29,35,39,40), and 6 studies confirmed seizures only by clinical manifestations (23,25,33,36,42,44). Nine studies defined seizure cessation on EEG within 24 h as a primary outcome (3,8,24,25,31,32,34,37,39), some studies contained longer seizure control times (48 h−7 d) (29,30,33,38,44), and 7 articles did not describe the seizure control times (21,22,35,36,40,41,43). One study defined seizure remission ≥ 50% by EEG within 24 h as the primary outcome (7), and another study defined seizure reduction ≥ 50% clinically as the secondary outcome (42).…”

Section: Summary Of the Main Resultsmentioning

confidence: 99%

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Efficacy of levetiracetam as first-line therapy for neonatal clinical seizures and neurodevelopmental outcome at 12 months of age

Cited by 10 publications

References 30 publications

Efficacy and Safety of Levetiracetam vs. Phenobarbital 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

Etiology, Clinic and Prognosis of Seizures in Preterm and Term Neonates: A Retrospective Study

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