Abstracts

Rationale: Our objective was to evaluate the efficacy and tolerability of levetiracetam (LEV) in the treatment of neonatal seizures. LEV is a FDA approved antiepileptic drug for adjunctive therapy in the treatment of partial onset seizures in patients 4 years of age and older, of myoclonic seizures in patients 12 years of age and older, and of primary generalized tonic-clonic seizures in patients 6 years of age and older. There is little data on its use in newborns.Methods: We retrospectively reviewed the records of neonates with electrographically confirmed seizures treated with LEV at our institution between 2006-2010. The following data were collected: gender, weight, gestational age, seizure type and etiology, age at initiation of LEV treatment, EEG results, name and number of prior antiepileptic drugs (AEDs) used, LEV dose, treatment response, and adverse events. Results: Fourteen children were identified (mean gestational age 33.7 weeks,). Mean age at onset of seizures was 3.8 days, and treatment of LEV started at a mean age of 20.5 days of life, and at an average post-conceptional age of 36.6 weeks. Etiology of seizures was hypoxic ischemic encephalopathy (5), sepsis (5), cortical dysplasia (2), CNS tumor (1), and cryptogenic (1). LEV was used as adjunctive therapy in all patients. Mean number of AEDs tried prior to LEV was 1.3; all children had been treated with at least phenobarbital prior to adding LEV. Mean starting dose of LEV was 24.1 mg/kg/day, and mean maintenance dose was 40.0 mg/kg/day. Seven (50%) patients had a mean decrease in seizure frequency of >50% with 6 of them becoming seizure free. The other 7 reported no change or worsening of seizures. Five of the seven patients who didn t respond to LEV died before discharge due to underlying complications of illness not related to seizure or LEV. There were no adverse events noted. Conclusions: LEV is effective and well tolerated as adjunctive therapy in the treatment of neonatal seizures.