Lack of response to treatment with levetiracetam in extreme preterm infants with seizures

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

“…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.…”

“…A recent study conducted by Kurtom et al [4], including only extremely preterm infants, evaluated the effectiveness of monotherapy with levetiracetam as a first-line treatment in achieving seizure cessation in extremely preterm infants with seizures. This single-center study retrospectively reviewed 61 extremely preterm infants and showed that 74% of their patients did not respond to LEV monotherapy and required additional medications.…”

“…Seizures are one of the most common and serious neurological emergencies in the neonatal period [1,2]. Neonatal seizures occur in 1-3 per 1000 term newborns and it may increase up to 10-130 per 1000 in preterm neonates [2][3][4]. The neonatal period is the most important period of life for developing seizures, because neonatal seizures, especially if prolonged, were reportedly associated with poor neurodevelopmental outcomes, as it may negatively affect the immature brain of premature infants [1,5,6].…”

“…Neonatal seizures usually manifest with stereotypical muscular activity or autonomic changes, and are a result of abnormal electrical discharges in the central nervous system of neonates, occurring within the first 28 days after birth in fullterm infants or until 44 weeks of gestational age in preterm infants [1,4,7]. The etiologies of neonatal seizures are reported in a broad spectrum, such as hypoxic-ischemic encephalopathy (HIE), infections, metabolic and electrolyte disturbances, brain injuries, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and brain malformations [1,8].…”

“…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.…”