Abstracts

Neonatal seizures frequently persist despite conventional treatment with phenobarbital, phenytoin or benzodiazepines. Newer antiepileptics (AEDs) may offer advantages in refractory neonatal seizures by introducing novel mechanisms of action, minimizing interactions with other medications, and offering alternatives for long-term management with possibly fewer side effects. Levetiracetam (LEV) is a novel AED recently released in solution. There is no data on its use in infants under six months. We have used liquid LEV in refractory neonatal seizures. We conducted a retrospective chart review of seven neonates who received LEV to assess safety and tolerability in this population. Seven infants from 1 day to 3 months old had previously failed management with conventional AEDs. Indications for treatment included refractory status epilepticus (4) and persistent intermittent seizures despite treatment with conventional anticonvulsants (3). Related diagnoses included congenital brain malformation (1), neonatal stroke (1), remote IVH and HIE (1), and genetic/metabolic syndromes (4). Patients in status epilepticus received an oral loading dose of 60 mg/kg/day by a nasogastric tube. Maintenance doses of LEV ranged from 30 to 60 mg/kg/day, divided two to three times per day. Trough blood levels were measured in 4/7 infants. Outcome measurements included clinical seizure control, clinical monitoring for adverse effects, and survival. Duration of treatment ranged from 10 days to 12 months. Trough levels ranged from 11 to 45 mcg/ml . No patient developed any clinically apparent adverse effect during treatment with LEV. Clinical seizures decreased or disappeared in 5/7 patients after initiating LEV. Two patients had EEG monitoring that documented this clinical response. Two patients died of their underlying degenerative neurologic diseases. 4/5 survivors remained seizure-free on LEV monotherapy at last follow-up. LEV was well tolerated by this small group of neonates with critical illness. Further studies should be performed to assess its efficacy and safety in larger groups of infants