Effect of Levetiracetam in the Treatment of Refractory Seizure in Infants through EEG: The Case of the Neonatal Intensive Care Unit of Tehran’s Children’s Medical Center

Abstract

Objective: Phenobarbital, phenytoin and Benzodiazepins are the most common treatments for resistant neonatal seizure [1]. Drug of choice in the treatment of neonatal seizure should be more effective and have fewer side effects. This study examines the effect of Levetriacetam (LEV) in the treatment of resistant neonatal seizure, using EEG (electroencephalogram). Methods: This is a clinical trial study that lasted 1 year, from March 2016 to March 2017. 20 neonates with early detection of seizure were hospitalized at the NICU of Children’s Medical Center in Tehran. These neonates included both term and preterm neonates over 30 weeks and more than 2000 gr, who did not respond to a single dose of Phenobarbital and Phenytoin. The results of statistical tests were analyzed and significant level was considered (p<0.05). Results: 85% of the patients were male with average age of 13 days. The most common cause of seizure in 45% cases was Hypoxic-Ischemic Encephalopathy (HIE). 65% of the newborns were seizure free after 24 hours of taking LEV whereas 80% of them after 72 hours. The 3 neonates who did not respond to LEV were endotracheal intubation. The average loading dose of LEV was 32±10.5, and the average maintenance dose was 18±8.3. No side effects were observed in using LEV. Conclusion: The findings of this study suggest that LEV is effective in unresponsive seizure to Phenobarbital and Phenytoin. It can, equally, reduce seizure frequency in newborns. Due to very low side effects and transient, it can also be used as a second-line therapy in the treatment of resistant neonatal seizure. However, multi-centered studies with a higher sample volume in the form of clinical trial are needed for further investigations on this topic.