Abstract
BackgroundNeonatal seizures remain a significant clinical problem, and therapeutic options are still not diverse with limited efficacy. Levetiracetam (LEV) is a relatively new and wide spectrum anti-seizure medication with favorable pharmacokinetics and safety profile. In the recent decades, LEV has been increasingly used for the treatment of neonatal seizures. The aim of this study was to describe the experience of using LEV as the first line anti-seizure medication for preterm infants.MethodsA retrospective analysis of 37 preterm infants who were treated with LEV as the first-line anti-seizure medication was performed.ResultsMean gestational age of the 37 preterm infants was 31.5 ± 1.9 weeks (range, 26 to 36+ 6 weeks). Twenty-one infants (57%) were seizure-free while given LEV at the end of the first week, and no additional anti-seizure medication was required. Loading doses of LEV ranged from 40 to 60 mg/kg (mean 56 mg/kg) and the maintenance dose ranged from 20 to 30 mg/kg (mean 23 mg/kg). No adverse effect was observed.ConclusionsLevetiracetam can be a good and safe choice for treatment of neonatal seizures in preterm infants. Prospective double blind controlled studies are needed in the future.
Highlights
Neonatal seizures remain a significant clinical problem, and therapeutic options are still not diverse with limited efficacy
Gestational ages and body weights The gestational age of 37 preterm infants ranged from 26 to 36+ 6 weeks
Onset of neonatal seizures Neonatal seizures occurred within 30 min to 45 days after birth
Summary
Neonatal seizures remain a significant clinical problem, and therapeutic options are still not diverse with limited efficacy. The aim of this study was to describe the experience of using LEV as the first line anti-seizure medication for preterm infants. Neonatal seizures are clinically defined as abnormal, stereotyped and paroxysmal dysfunctions in the central nervous system (CNS), occurring within the first 28 days after birth in full-tem infants or before 44 weeks of gestational age in preterm infants. It is the most common neurological event in neonates, indicating a variety of different pre-, peri-, or postnatal diseases of the CNS. Seizures occur more often during the neonatal period compare to other periods in the life span. Currently, a consensus has not been reached regarding the second-line anti-seizure medication such as fosphenytoin, benzodiazepine, levetiracetam (LEV), or lidocaine [5, 6]
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