Abstracts

Rationale: Levetiracetam is a novel AED indicated for adjunctive treatment of partial seizures in patients greater than 4 years of age; however, a significant percentage of pediatric neurologists recommend levetiracetam as second, third, or subsequent agent for neonatal seizures. The purpose of this retrospective chart-review study is to review the epidemiological characteristics, etiologies, and risk factors and subsequent efficacy of treatment of neonates that were treated with levetiracetam in an NICU setting. Methods: We performed a search for patients treated at the Texas Children s Hospital (TCH) Neonatal Intensive Care Unit (NICU) between Jan. 1, 2004 and Dec. 31, 2008. Their medical records were reviewed for age at treatment, gestational age, diagnoses, imaging and EEG findings, treatment with anti-epilepsy drugs (AEDs), and response to treatment. Results: Our search identified 20 patients (14 female, 6 male) who were treated with levetiracetam in the TCH NICU between 2004 and 2008. Pediatric neurology was the prescribing service in all cases. Median age at diagnosis was 0.75 months (range .07-2.56 months). Most patients (n=14) were born at full-term; 3 were premature with gestational ages of 31-34 weeks. Patients had generalized (n=10), partial (n=5), or partial with secondary generalization (n=4); data was not available for 1 patient. Several patients had genetic or chromosomal abnormalities (n=7), including 2 cases of nonkeratotic hyperglycinemia. CNS infection was present in 6 cases, including CMV and HSV encephalitis. 2 patients had evidence of hypoxic injury to the brain. There were 12 patients with abnormal findings on MRI of the brain, including holoprosencephaly, small infarcts, and cortical dysplasias. EEG revealed focal seizure activity (n=9), generalized seizure activity (n=5), or no abnormalities (n=5). The patients were initially treated most often with phenobarbital (n=15). Levetiracetam was most commonly the 2nd or 3rd drug of choice (n=7, n=6 respectively) but also was the 1st (n=3), 4th (n=3), and 5th (n=1). It was used in conjunction with other AEDs including phenobarbital and fosphenytoin in 15 cases, and used as a single agent in 5 cases. Patients were treated to a median dose of 40 mg/kg/day (range 10-120 mg/kg/day). Seizure frequency improved in 10 cases, including 8 patients who were noted to be seizure-free during their hospital course. Two patients did not improve and had to be readmitted for seizure treatment. Seizure frequency was not recorded for 8 patients. Conclusions: Our results demonstrate that levetiracetam may be used in conjunction with other AEDs to treat various classes of difficult-to-control seizures in the NICU. Our data suggest that there may be a reduction of seizure frequency with levetiracetam; however, more research is needed to evaluate its safety and efficacy in neonates.