Response of levetiracetam in neonatal seizures

Table 1 Clinical characteristics of neonates receiving levetiracetam

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7	Patient 8	Patient 9	Patient 10	Patient 11	Patient 12
Gestation (wk)	38	39	35	38	41	29	36	23 6/7	30	39	36	40
Apgar score (1 and 5 min)	9, 10	9, 10	9, 10	9, 10	8, 10	7, 9	0, 0	4, 6	0, 0	0, 0	0, 0	4, 7
Age of seizure onset (days of life)	19	10	8	1	1	0	0	3	0	0	0	0
Etiology	GBS meningitis	HSV encephalitis	Suspected mitochond-rial	Hypoglycemia	Sulphite oxidase deficiency	E. Coli meningitis	HIE	HIE	HIE	HIE	HIE	HIE
Neuroimaging	Cystic encephalo-malacia	Cystic encephalo-malacia	Cystic encephalo-malacia	Normal	Cystic encephalo-malacia	Hydrocephalus with generalized atrophy	Cystic encephalo-malacia	Cystic encephalo-malacia	Peri-ventricular leukomalacia	Normal	Peri-ventricular leukomalacia	Diffuse cystic encephalo-malcia
Electrographic seizures	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Clinical status epilepticus	No	No	No	No	No	Yes	No	No	No	No	No	Yes
Hypothermia	-	-	-	-	-	-	No	No	No	Yes	Yes	Yes
Anticonvulsant order	PHB/MDZ/LEV	PHB/LEV	PHB/LEV	PHB/LEV	PHB/LEV	PHB/MDZ/THI/LEV	PHB/MDZ/LEV	PHB/MDZ/LEV	PHB/MDZ/LEV	PHB/MDZ/LEV	PHB/MDZ/LEV	PHB/MDZ/LEV/THI
LEV loading dose (mg/kg)	15	20	10	7.5	10	10	15	16	18	10	8	20
Mm maintenance (mg/kg per day)	27	40	20	60	20	30	36	5	36	20	15	40
Seizure after 24 h	No	No	No	No	No	Yes	Yes	No	Yes	Yes	No	Yes
Seizure after 72 h	No	No	No	No	No	No	No	No	Yes	Yes	No	Yes
Anticonvulsant at discharge	LEV	TPM/LEV	PHB/LEV	PHB/LEV	Not applicable	TPM/LEV	Not applicable	LEV	LEV/TPM	LEV	PHB/LEV	PHB/LEV
Outcome	Mild delay	Severe delay	Severe delay	Normal	Death	Severe delay	Death	Severe delay	Moderate delay	Mild delay	Severe delay	Severe delay

GBS: Group B streptococcus; HSV: Herpes simplex virus; HIE: Hypoxic ischemic encephalopathy; PHB: Phenobarbitone; MDZ: Midazolam; LEV: Levetiracetam; THI: Thiopentone; TPM: Topiramate.

Table 2 Literature review of levetiracetam use in neonates

Ref.	Year of publication	No. of patients	Drugs used before LEV	Outcome: Seizure	No. of patients with HIE	Seizure outcome in HIE patients	Dosage (loading)(mg/kg)	Dosage (maintenance) (mg/kg per day)	Remarks
Shoemaker et al[4]	2007	3	PHB/MDZ/fPHT	All seizure free	1	Seizure controlled within 17 min of oral bolus	60 (oral)	30
Fürwentsches et al[5]	2010	6	PHB	All seizure free in 6 d	1	Seizure free	NA	10-50	Prospective
Ledet et al[6]	2010	1	PHB	Seizure free	0	NA	NA	40
Ramantani et al[7]	2011	38	NA	30 seizure free at 1 wk	9	NA	10	45-60	Prospective
Khan et al[8]	2011	22	PHB or PHT	19 seizure cessation at 1 h and 22 seizure free by 72 h	12	11 seizure cessation at 1 h
Abend et al[9]	2011	23	PHB or PHT	7 seizure terminated, 1 reduced seizure > 50%, 1 seizure terminated in > 24 h, 2 improvement in > 24 h, 8 no improvement, 1 unable to judge	8	2 seizure terminated, 2 reduced seizures > 50%, 1 improvement in > 24 h, 2 no improvement, 1 unable to judge	5-22	10-80	LEV as first drug in 4 cases
Aylward et al[10]	2011	1	fPHT	Partially responsive	0	NA	20	19
Sharpe et al[11]	2012	18	PHB	6 seizure controlled	8	NA	20-40	5-10
Rakshasbhuvankar et al[12]	2013	8	PHB/PHT/MDZ	6 "excellent", 1 partial, 1 ineffective	5	4 "excellent", 1 "partial"	5-10	10-35
Khan et al[13]	2013	12	PHB	9 seizure stopped in 24 h	5	3 seizure stopped in 24 h, 1 no response, 1 NA	25-50	50
Kirmani[14]	2014	12	PHB	10 seizure free by 72 h	5	NA	25-50	25-50

PHB: Phenobarbitone; PHT: Phenytoin; MDZ: Midazolam; fPHT: Fosphenytoin; NA: Not available or applicable; HIE: Hypoxic ischemic encephalopathy; LEV: Levetiracetam.