levetiracetam as the first-line antiepileptic in neonatal seizures

Background: the quest persists for an ideal newer antiepileptic drug (aed) with better efficacy and tolerability. levetiracetam (lev) is one of these aeds with a novel mechanism of action, good pharmacokinetic profile, acceptable tolerability, and side-effect profile. the present study assessed the safety and efficacy of intravenous levetiracetam as a first-line aed in neonatal seizures. methods: this prospective observational study was conducted on all term neonates with seizures admitted to the neonatal intensive care unit (nicu) of a tertiary care center. neonates with hypoglycemia, hypocalcemia, hypomagnesemia, inborn errors of metabolism, or those who received other aeds prior to admission were excluded from the study. 20mg/kg intravenous lev was administered as first-line aed and graded up to 40mg/kg if seizures were not controlled in 2 h; thereafter, second-line aed was added. results: only 36.2% (21/58) of the cases responded to lev as first-line aed. hypoxic ischaemic encephalopathy(hie) was the most common etiology of seizures (55.2%). subtle seizures were most responsive to lev (60%), while multifocal clonic seizures (22.3%) responded the least. no adverse effect of lev was observed during the study period.conclusion: only 36.2% of the cases responded to lev as first-line aed, and subtle seizures were the most responsive seizures. therefore, the efficacy of lev as first-line aed in neonatal seizures is yet to be proven by a larger study. there were no adverse effects of lev during the study period indicating the relative safety of this drug.