Abstract
Hypoglycemia, hypocalcaemia and hypomagnesaemia cause seizures in newborns. Furthermore, vitamin B6 dependent and benign newborn seizures should be considered. Seizures often are the result of CNS-infections, brain hemorrhage or infarction, malformation or hypoxic damage. In case seizures persist despite glucose, magnesium, calcium or vitamin B6 supplementation, phenobarbital (PB) represents the anticonvulsant drug of choice. In the last years increase in neuronal apoptosis was described following PB treatment in animal models. Furthermore, impairment of cognitive function was implied. Levetiracetam (LEV) is a newer antiepileptic drug with proven efficacy beyondy the age of four years and a favorable profile regarding apoptosis. In a monocentric feasibility study, LEV monotherapy was applied in newborn seizures. In 5 infants (gestation age 24–30 weeks, birth weight 600–1370g), hypoglycemia, hypocalcaemia, hypomagnesaemia and vitamin B6 dependent seizures were ruled out and, following failure of PB to control seizures, LEV was applied with informed parental consent. PB was discontinued and 10mg/kg increments up to 30–50mg/kg LEV were administered (intravenously, then orally) over 3 days. EEGs and LEV-titers were monitored. Infants were seizure free on the fourth day of treatment with 28–44mg/kg LEV, while EEGs markedly improved in 4/5 patients towards the end of the first week. The LEV plasma levels were 20,6–26,0µg/ml under intravenous/oral administration (reference values 5–65,0µg/ml). In 3 cases, LEV was discontinued after 3 months seizure-freedom. In our study, preterm infants were seizure free shortly after treatment initiation. LEV plasma-levels were within therapeutic range, while no severe adverse effects were observed. These results point to LEV as a reasonable alternative to PB in newborn seizures, although a multicenter, double blind study is called for in order to confirm this assumption.
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