Efficacy of Levetiracetam in the Treatment of Neonatal Seizures Presenting at Tertiary Care Hospital
DOI:
https://doi.org/10.54112/bcsrj.v6i5.2270Keywords:
Neonatal seizures, Levetiracetam, Phenobarbitone, Antiepileptic drugsAbstract
Neonatal seizures are the most frequent neurological emergency during the neonatal period and are associated with considerable morbidity and mortality. Conventional antiepileptic drugs, particularly phenobarbital and phenytoin, remain widely used but may have limited efficacy and a higher adverse-effect profile. Levetiracetam has emerged as a potential alternative because of its favorable safety profile and anticonvulsant activity. Objective: To determine the efficacy and safety of levetiracetam in the treatment of neonatal seizures presenting at a tertiary care hospital and to compare its outcomes with conventional antiepileptic therapy using phenobarbital with or without phenytoin. Methods: This prospective, double-blinded, randomized, parallel-group controlled trial was conducted in the Neonatal Intensive Care Unit of Head Quarter Hospital, Dera Ismail Khan, from 25 October 2024 to 25 March 2025. A total of 260 neonates aged 0–28 days with clinically diagnosed neonatal seizures were enrolled and randomly allocated into two equal groups. Group A received intravenous levetiracetam, while Group B received phenobarbital with or without phenytoin according to clinical requirement. Treatment efficacy was assessed in terms of seizure cessation within 40 minutes, seizure freedom at 24 and 48 hours, seizure recurrence, and time to seizure control. Safety was evaluated by documenting adverse effects and mortality. Data were analyzed using SPSS version 23. Quantitative variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Chi-square test and independent sample t-test were applied where appropriate, and a p-value ≤0.05 was considered statistically significant. Results: Early seizure cessation within 40 minutes was significantly higher in the levetiracetam group than in the conventional antiepileptic group (64.7% vs. 52.3%, p=0.04). Mean time to seizure control was shorter in Group A compared with Group B (28 ± 12 minutes vs. 33 ± 15 minutes, p=0.05). Adverse effects were significantly less frequent among neonates receiving levetiracetam than among those receiving phenobarbital with or without phenytoin (8% vs. 18%), particularly sedation and poor feeding. Seizure freedom at 24 and 48 hours, seizure recurrence, and mortality were comparable between the two groups. Hypoxic-ischemic encephalopathy and sepsis were the most common underlying etiologies of neonatal seizures. Conclusion: Levetiracetam demonstrated better early seizure control and a lower frequency of adverse effects compared with conventional antiepileptic therapy in neonates with seizures. It may be considered a safer and effective alternative to phenobarbital-based therapy, with comparable short-term seizure freedom and mortality outcomes.
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Copyright (c) 2025 Fawad Ahmad, Farmanullah Burki, Gohar Ali, Muhammad shafiq, Mehtab Ahmad Khan
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