Levetiracetam as mono-and polytherapy in the treatment of neonatal-onset seizures

Objectives: In recent years, there is great interest in the use of levetiracetam which is a broad-spectrum anti-seizure drug (ASD) for neonatal-onset seizures. The study aims to compare the patient characteristics and neurodevelopmental outcomes in infants who were received levetiracetam monotherapy or polytherapy comprising levetiracetam and other ASDs for neonatal-onset seizures. Methods: The study was conducted on 139 children who were received levetiracetam monotherapy as the first-line anti-seizure treatment or polytherapy comprising levetiracetam and other ASDs for neonatal-onset seizures and followed-up in a pediatric neurology outpatient clinic from June 2014 to January 2022. Results: Of the 139 patients, 64% (n=89) were treated with levetiracetam monotherapy, and 36% (n=50) with polytherapy. Levetiracetam monotherapy was significantly more effective in patients with unknown etiologies than those with specific underlying etiologies (p=0.04). Abnormal pretreatment electroencephalogram and brain magnetic resonance imaging findings were significantly more frequent in patients received polytherapy (p=0.01, p=0.01). The rate of neurodevelopmental disabilities was significantly higher in patients receiving polytherapy than those receiving levetiracetam monotherapy (p=0.01). Normal pretreatment EEG was the strongest predictor of seizure control under levetiracetam monotherapy (OR=10; 95% CI=2.9–35.7; p<0.001). No adverse effects were reported in any patients in both groups. Conclusion: Our findings suggest that levetiracetam monotherapy is effective for the treatment of neonatal-onset seizures, especially in the treatment of neonatal epilepsies with unknown etiologies. Neonates with abnormal electroencephalogram and brain magnetic resonance imaging findings are more likely to be treated with multiple ASDs.
Keywords: Levetiracetam, monotherapy, polytherapy, neonatal, seizure.