Oral Levetiracetam as Add-On Therapy in Neonatal Seizures
Iranian Journal of Child Neurology,
Vol. 12 No. 4 (2018),
5 September 2018
Background: Seizure is the most common signs of nervous system disease in neonates.The first line of treatments in neonatal seizures (after ruling out and emergency treatment of electrolyte imbalance and hypoglycemia) are, phenobarbital and phenytoin. At least, 35%-45% of seizures may not be controlled by first-line drugs, so further treatment would be necessary. Levetiracetam has shown its safety and efficacy in treatment of neonatal seizures. We aimed to evaluate drugs that are more effective concerning neonatal seizure.
Methods: Initially, 245 neonates presented with seizure in neonatal wards &NICUs(level IIa&IIb) in Qom hospitals,were enrolled in this clinical trial study(inclusion criteria). The main causes of seizure in 12 neonates were electrolyte imbalance and hypoglycemia,therefore, they were excluded from the study. Phenobarbital and then if needed, phenytoin administered to the remaining neonates, as first line treatment.Eventually, 42 neonates with a diagnosis of resistant seizure to these drugs were challenged with oral levetiracetam. Data was analysed using SPSS ver. 20.(Chicago,IL,USA). The study was registered as code number of IRCT2016051527896N1.
Results: In this study,85.8% of seizures were controlled with initial dosage of oral levetiracetam and 9.5% by increasing the dose but 4.7% were not cured .
Conclusion: when the intravenous form of levetiracetam is not available and neonatal seizure not respond to first line classic drugs,oral levetiracetam as add on therapy is effective.Keywords: Neonatal seizure, Oral levetiracetam, treatment
- Neonatal seizure
- Oral levetiracetam
Johnston MV. Seizure in childhood. In: Behrman RE, Kliegman RM, Jenson HB, Editors.
Nelson Textbook of Pediatrics. 17th ed. Philadelphia: Saunders; 2004;P 1993-2009.
Menkes JH, Snake R. Textbook of child neurology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2000. P. 919-1007.
Arzimanoglou A, Guerrini R, Aicardi J. Occasional seizures other than febrile convulsions, Aicardi's epilepsy in children. Philadelphia: Lippincott Williams & Wilkins;2004:p 235-40.
Dodson WE (1993).Felbamate in the treatment of Lennox-Gastaut syndrome.Epilepsia,34 (7), 18-24.
-Linda G.M. van Rooij ,Lena Hellström-Westas ,Linda S. de Vries Treatment of neonatal seizures ,2013; Volume 18, Issue 4,P 209–215.
-Hannah C. Glass. Neonatal Seizures: Advances in Mechanisms and management ,2014; 41(1);177-190.
Shellhaas RA, Soaita AI, Clancy RR. Sensitivity of amplitude-integrated electroencephalography for neonatal seizure detection. Pediatrics 2007; 120 (4): 770-7.
- Hellstrome-westas L, Blennow G, Lindroth M, Rosen I, Svenningsen NW. Low risk of seizure recurrence after early withdrawal of antiepileptic treatment in the neonatal period. Arch Dis Child 1995; 72:P 97-101.
Mohamad A.Mikati , Abeer J.Hani(2015).Seizure in Childhood, In:Nelson: pediatrics,2, 20th ed, Philadelphia:p 2823.
Volpe JJ (1989). Neonatal seizures: current concepts and revised classification. Pediatrics 84 (3): P 422-428.
Robert M.kliegman, Bonita F.stanton, Joseph w.staeme, Nina F.schor(2015).In: Nelson: pediatrics,20th ed, Philadelphia; 2849-2854.
Gregory L.Holmes(1987).Major Problems in Clinical Pediatrics.In: diagnosis and
management of seizures in children,1,30.Saunders, 220-250.
Panayiotopoulos CP. General aspects on the diagnosis of epileptic seizures and epileptic syndromes. In: Panayiotopoulos CP, editor. A clinical Guide to epileptic syndromes and their treatment. Oxford: Blandon Medical Publishing; 2002. p. 1-35.
Commission on Classification and Terminology of The International League Against Epilepsy. Proposal for revised Classification of Epilepsies and Epileptic Syndromes. Epilepsia1989; 30: 389-99.
Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia 1994; 35 Suppl 2:P 1-6.
Serdaroglu A, Ozkan S, Aydin K, Gucuyener K, Tezcan S, Aycan S. Prevalence of epilepsy in Turkish children between the ages of 0 and 16 years. J Clin Neurol 2004; 19:P 271-5.
Hauser WA. Seizure disorders: The changes with age. Epilepsia 1992; 33 Suppl 4: 6-14.
Arzimanoglou A, Guerrini R, Aicardi J. Epilepsy: Overwiew and definitions. In: Aicardi's Epilepsy in children. 3rd ed. London: Lippincott Williams & Wilkins; 2004. p. 1-6.
Martin R J, Fanaroff AA , Walsh MC . Neonatal-Perinatal Medicine . 10 nd ed. Philadelphia,
;Volume 2,P 946.
Brunquell PJ, Glennon CM, Dimario FJ, Lever T, Eisefeld L. Prediction of outcome based on clinical seizure type in newborn infants. J Pediatr 2004, 140: 707-12.
Davidson DL (1993). The need for guidelines on the use of rectal diazepam. Seizure 2 (1): 1- 4.
- Goodman-Louis-Sanford, Gilman-Alfred. The Pharmacological Basis of Therapeutics. 9th ed, New York, McGraw-Hill. 1996; P 478-85.
-Nimaga K, Desplants D, Doumbo O, et al. Treatment with phenobarbital and monitoring of epileptic patients in rural Mali. Bull World Health Organ 2002: 80 (7); 532-7.
Lerman-Sagie T, Lerman P. Phenobarbital still has a role in epilepsy treatment. J Child Neurol 1999; 14 (12): 820-1.
- Burgers M. Phenobarbital and Primdone. In: Wyllie E ed. The treatment of epilepsy principles and practice. 3 rd ed. Philadelphia, Lippincott Willias & wilkins, 2001; pp: 869-879.
Sedighi M, Asadi F, Moradian N, Vakiliamini M, Moradian M. Efficacy and safety of levetiracetam in the management of seizures in neonates.(2016);21(3).
Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998; 339: 792-8.
Goraya JS, Khurana DS, Valencia I, et al. Intravenous levetiracetam in children with epilepsy. Pediatr Neurol 2008; 38: 177-80.
Shoemaker MT, Rotenberg JS. Levetiracetam for the treatment of neonatal seizures. J Child Neurol 2007; 22: 95-98.
Allison L Mruk, Karen L Garlitz , Noelle R Leung. Levetiracetam in neonatal seizures .In: J Pediatr Pharmacol , (2015); Mar-Apr;20(2):P 76-89.
Ramantani G, Ikonomidou C, Walter B, Rating D, Dinger J. Levetiracetam: safety and efficacy in neonatal seizures. Eur J Paediatr Neurol 2011; 15: 1-7.
Khan O, Chang E, Cipriani C, Wright C, Crisp E, Kirmani B. Use of intravenous levetiracetam for management of acute seizures in neonates. Pediatr Neurol 2011; 44: 265-269.
Abhijeet Rakshasbhuvankar,Shripada Rao,Rolland Kohan,Karen Simmer,Lakshmi Nagarajan.(2013).Intravenous levetiracetam for treatment of neonatal seizures.Journal of Clinical Neuroscience,(20), P 1165-1167.
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