Original ArticleUse of Intravenous Levetiracetam for Management of Acute Seizures in Neonates
Introduction
Few medications have been studied and approved for the treatment of neonatal seizures, and none have exhibited superior efficacy over the others. With a high incidence of seizures refractory to currently approved antiepileptic drugs, a pressing need exists for alternative treatments in neonates. Seizures affect approximately 1-4 out of 1000 live births in North America, and constitute a major predictor of future adverse outcomes [1], [2]. The most common causes of neonatal seizures include hypoxic ischemic encephalopathy, intracranial hemorrhages, infections of the central nervous system, cerebral infarctions, and metabolic disturbances [1], [2]. The treatment of neonatal seizures is often of limited efficacy and leads to deleterious adverse effects. Two antiepileptic drugs presently approved by the United States Food and Drug Administration in the neonatal period, phenobarbital and phenytoin, demonstrate efficacy in less than 50% of cases and undesirable side-effect profiles in major studies [3], [4], [5], [6], [7], [8]. The off-label use of antiepileptic drugs in children and neonates is increasing, and an imperative need exists to investigate the use of newer antiepileptic drugs in neonates [9].
Levetiracetam is a pyrrolidine-derivative antiepileptic drug chemically different from all previous antiepileptic drugs, with a novel mechanism of action that remains incompletely understood. Intravenous levetiracetam was approved by the Food and Drug Administration in August 2006 for patients above 16 years of age. Both intravenous and oral levetiracetam have been increasingly used off-label in pediatric patients because of documentation in the literature of efficacy and safety in adults, along with favorable reports in younger patients [4], [5], [9], [10], [11], [12], [13], [14], [15]. We report on our experience with intravenous levetiracetam in the management of neonatal seizures.
Section snippets
Patients and Methods
Infants were eligible for inclusion if they were born at term gestational age (≥37 weeks) and received their first dose of intravenous levetiracetam during the neonatal period (0-28 days of age). A retrospective electronic medical record review was performed on all patients who met the inclusion criteria between January 2007 and December 2009 at our institution. This study was approved by our institutional review board.
Results
We retrospectively analyzed 22 neonates treated with intravenous levetiracetam at our institution. Several variables were taken into consideration (Table 1).
Discussion
Our data suggest that intravenous levetiracetam can be used for the management of acute seizures in neonates. The use of intravenous levetiracetam demonstrated immediate cessation of seizures in 86% (19/22) of our study patients. Painter et al. [6] and Boylan et al. [7] demonstrated efficacy in cessation of seizures among less than 50% of their patients treated with phenobarbital and phenytoin. In those studies, phenobarbital and phenytoin were used to treat a variety of neonatal seizure
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