Abstracts

Rationale: Neonatal seizures are defined as paroxysmal alterations in neurologic function that can be documented electroencephalographically with or without clinical manifestations. They affect approximately 1 to 4 of 1000 live births in North America and are a major predictor of future adverse neurologic outcomes. Currently approved antiepileptic drugs (AEDs) for neonatal seizures have been shown to have efficacy rates of less than 50% and can have undesirable side effect profiles. Levetiracetam (LEV) is an AED with a novel mechanism of action; the intravenous (IV) form is currently approved as adjunctive treatment for a variety of seizures in patients 16 years of age and older. Only limited data about the efficacy and safety of IV levetiracetam in acute seizure management in children is available and IV levetiracetam is currently not approved for patients <16 years. The goal of this study is to retrospectively assess the efficacy and tolerability of intravenous levetiracetam therapy in acute seizure management during the neonatal period. Methods: A retrospective chart review was conducted on all term and late preterm neonates who received intravenous levetiracetam at Scott & White Hospital / Texas A & M Health Science Center, Temple, TX between January 2007 and December 2009. Subject data were acquired from electronic medical records. Approval for this retrospective analysis of patient records was given by the hospital s institutional review board. Results: We retrospectively analyzed 22 neonates 12 females and 10 males with partial epilepsy who received intravenous levetiracetam at our institution . A bolus administration of 50 mg/kg was administered in most patients followed by a maintenance dose of 25 mg/kg every 12 hours. The given dose was infused over 15 minutes to an hour . Nineteen patients (86%) experienced immediate seizure control within one hour of the loading dose. These patients responded to intravenous levetiracetam both electrographically and clinically with improvement seen one hour after commencing the loading dose. No further seizures were recorded while on intravenous levetiracetam in 7 (32%) of neonates after loading. 14 patients (64%) achieved seizure freedom on IV levetiracetam within 24 hours of the loading dose 19 (86%) within 48 hours, and 22 (100%) within 72 hours. Twenty-two patients (100%) were switched to oral levetiracetam and of those, 18 (81%) were discharged home on oral levetiracetam monotherapy. No major immediate or long term adverse effects were reported. Duration of follow up ranges between 2- 6 months. Conclusions: Intravenous Levetiracetam appears to be safe and efficacious in acute seizure management in neonates.