IV Levetiracetam Short-Circuits Neonatal Seizures

SAN ANTONIO – Intravenous levetiracetam safely and effectively halted acute neonatal seizures within 72 hours in a retrospective study of 22 newborns treated with the drug at a Texas hospital.

The findings, if validated through larger studies, could represent a major shift in the management of neonatal seizures, said Dr. Owais Ahmed Khan of Scott & White Hospital/Texas A&M Health Science Center in Temple. "The antiepileptic medications that are currently approved for neonatal seizures – including phenobarbital, phenytoin, and lorazepam – are effective in less than 50% of newborns and can have serious long-term effects."

Neonatal seizures affect approximately 1-4 of 1,000 live births in North America and are a major predictor of adverse neurologic outcomes, "yet very few antiepileptic medications carry [a Food and Drug Administration–approved] indication for their treatment," Dr. Khan said at the annual meeting of the American Epilepsy Society.

Intravenous levetiracetam (Keppra) is approved as adjunctive treatment for various seizure types only in children aged 16 years and older, but "it is being increasingly used off label in pediatric patients because of literature documenting efficacy and safety in adults, along with favorable anecdotal reports in younger patients," he said.

To evaluate the efficacy and tolerability of intravenous levetiracetam therapy for acute seizure management during the neonatal period, Dr. Khan and colleagues reviewed the charts of all term and near-term neonates who received the drug at their institution between January 2007 and December 2009. The 12 female and 10 male newborns included in the analysis typically received a bolus dose of 50 mg/kg of levetiracetam followed by a maintenance dose of 25 mg/kg every 12 hours, infused over 15 minutes to 1 hour.

"Nineteen of the newborns [86%] experienced immediate seizure control within 1 hour of the loading dose," Dr. Khan reported, noting that they responded both electrographically and clinically.

After the loading dose, no further seizures were recorded while on intravenous levetiracetam in seven (32%) of the newborns. Seizures stopped altogether within 24 hours of the loading dose in 14 patients (64%) and within 48 hours in 19 patients (86%). All 22 were seizure free within 72 hours, he said.

All of the newborns were switched to oral levetiracetam while in the hospital, and 81% were discharged home on levetiracetam monotherapy, Dr. Khan reported, adding that no major or immediate adverse effects were reported during follow-up, which ranged from 2 to 6 months.

Dr. Khan reported that he and his colleagues had no financial disclosures.

SAN ANTONIO – Intravenous levetiracetam safely and effectively halted acute neonatal seizures within 72 hours in a retrospective study of 22 newborns treated with the drug at a Texas hospital.

The findings, if validated through larger studies, could represent a major shift in the management of neonatal seizures, said Dr. Owais Ahmed Khan of Scott & White Hospital/Texas A&M Health Science Center in Temple. "The antiepileptic medications that are currently approved for neonatal seizures – including phenobarbital, phenytoin, and lorazepam – are effective in less than 50% of newborns and can have serious long-term effects."

Neonatal seizures affect approximately 1-4 of 1,000 live births in North America and are a major predictor of adverse neurologic outcomes, "yet very few antiepileptic medications carry [a Food and Drug Administration–approved] indication for their treatment," Dr. Khan said at the annual meeting of the American Epilepsy Society.

Intravenous levetiracetam (Keppra) is approved as adjunctive treatment for various seizure types only in children aged 16 years and older, but "it is being increasingly used off label in pediatric patients because of literature documenting efficacy and safety in adults, along with favorable anecdotal reports in younger patients," he said.

To evaluate the efficacy and tolerability of intravenous levetiracetam therapy for acute seizure management during the neonatal period, Dr. Khan and colleagues reviewed the charts of all term and near-term neonates who received the drug at their institution between January 2007 and December 2009. The 12 female and 10 male newborns included in the analysis typically received a bolus dose of 50 mg/kg of levetiracetam followed by a maintenance dose of 25 mg/kg every 12 hours, infused over 15 minutes to 1 hour.

"Nineteen of the newborns [86%] experienced immediate seizure control within 1 hour of the loading dose," Dr. Khan reported, noting that they responded both electrographically and clinically.

After the loading dose, no further seizures were recorded while on intravenous levetiracetam in seven (32%) of the newborns. Seizures stopped altogether within 24 hours of the loading dose in 14 patients (64%) and within 48 hours in 19 patients (86%). All 22 were seizure free within 72 hours, he said.

All of the newborns were switched to oral levetiracetam while in the hospital, and 81% were discharged home on levetiracetam monotherapy, Dr. Khan reported, adding that no major or immediate adverse effects were reported during follow-up, which ranged from 2 to 6 months.

Dr. Khan reported that he and his colleagues had no financial disclosures.

SAN ANTONIO – Intravenous levetiracetam safely and effectively halted acute neonatal seizures within 72 hours in a retrospective study of 22 newborns treated with the drug at a Texas hospital.

The findings, if validated through larger studies, could represent a major shift in the management of neonatal seizures, said Dr. Owais Ahmed Khan of Scott & White Hospital/Texas A&M Health Science Center in Temple. "The antiepileptic medications that are currently approved for neonatal seizures – including phenobarbital, phenytoin, and lorazepam – are effective in less than 50% of newborns and can have serious long-term effects."

Neonatal seizures affect approximately 1-4 of 1,000 live births in North America and are a major predictor of adverse neurologic outcomes, "yet very few antiepileptic medications carry [a Food and Drug Administration–approved] indication for their treatment," Dr. Khan said at the annual meeting of the American Epilepsy Society.

Intravenous levetiracetam (Keppra) is approved as adjunctive treatment for various seizure types only in children aged 16 years and older, but "it is being increasingly used off label in pediatric patients because of literature documenting efficacy and safety in adults, along with favorable anecdotal reports in younger patients," he said.

To evaluate the efficacy and tolerability of intravenous levetiracetam therapy for acute seizure management during the neonatal period, Dr. Khan and colleagues reviewed the charts of all term and near-term neonates who received the drug at their institution between January 2007 and December 2009. The 12 female and 10 male newborns included in the analysis typically received a bolus dose of 50 mg/kg of levetiracetam followed by a maintenance dose of 25 mg/kg every 12 hours, infused over 15 minutes to 1 hour.

"Nineteen of the newborns [86%] experienced immediate seizure control within 1 hour of the loading dose," Dr. Khan reported, noting that they responded both electrographically and clinically.

After the loading dose, no further seizures were recorded while on intravenous levetiracetam in seven (32%) of the newborns. Seizures stopped altogether within 24 hours of the loading dose in 14 patients (64%) and within 48 hours in 19 patients (86%). All 22 were seizure free within 72 hours, he said.

All of the newborns were switched to oral levetiracetam while in the hospital, and 81% were discharged home on levetiracetam monotherapy, Dr. Khan reported, adding that no major or immediate adverse effects were reported during follow-up, which ranged from 2 to 6 months.

Dr. Khan reported that he and his colleagues had no financial disclosures.