Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Faculty of Medicine, American University of Beirut, Lebanon.
Seizure. 2020 Nov;82:7-11. doi: 10.1016/j.seizure.2020.08.030. Epub 2020 Sep 8.
Neonatal seizures are frequently encountered in the neonatal intensive care unit and may be associated with serious long-term neurological sequelae. Response to treatment continues to be modest, and treatment guidelines remain unclear. The use of levetiracetam has been on the rise in the past several years due to its favorable safety profile in the face of limited data on its efficacy and optimal dosing regimens. Unlike the older age groups, the benefit of escalating to high-dose levetiracetam of 80-100 mg/kg/day in neonates not responding to the standard used dosing regimen (40-60 mg/kg/day) is not studied. We sought to investigate the safety and efficacy of levetiracetam escalation to high dose regimens for neonatal seizures.
A retrospective chart review over a 7-year period was conducted at the American University of Beirut to identify neonates with electrographically proven seizures treated with levetiracetam. Data was collected on electroclinical seizure characteristics, underlying etiology, seizure control, other anti-seizure medications, and adverse effects.
Electronic chart review revealed a total of 15 neonates with electrographically confirmed seizures treated with levetiracetam, with escalation to high doses in seven. As a first line drug, levetiracetam monotherapy terminated seizures in six out 10 neonates, two of whom had complete seizure cessation only after escalation to high doses of 80 or 100 mg/kg/day. When used in combination with other anti-seizure medications, four out of five neonates achieved complete seizure cessation upon escalation to high doses of levetiracetam. No adverse effects were noted.
In neonates not responding to the standard used levetiracetam doses, incremental increases to 80-100 mg/kg/day may be considered. Prospective studies are needed to confirm the promising role of such high dosing regimens, and to better elucidate the role of levetiracetam in neonatal seizures.
新生儿惊厥在新生儿重症监护病房中经常遇到，可能与严重的长期神经后遗症有关。尽管治疗效果仍然有限，但治疗指南仍不明确。在过去的几年中，由于其在疗效和最佳剂量方案方面的数据有限，但具有良好的安全性，左乙拉西坦的使用有所增加。与年龄较大的群体不同，对于未能对标准剂量方案（40-60mg/kg/天）做出反应的新生儿，将左乙拉西坦升级为高剂量（80-100mg/kg/天）的剂量方案的益处尚未得到研究。我们旨在研究左乙拉西坦升级为高剂量方案治疗新生儿惊厥的安全性和疗效。
在贝鲁特美国大学进行了为期 7 年的回顾性图表审查，以确定用电图表征的癫痫发作的新生儿接受左乙拉西坦治疗。收集了电临床发作特征、潜在病因、发作控制、其他抗癫痫药物和不良反应的数据。
电子图表审查共发现 15 名电图表征的新生儿癫痫发作接受左乙拉西坦治疗，其中 7 名升级为高剂量。作为一线药物，左乙拉西坦单药治疗在 10 名新生儿中有 6 名终止了发作，其中 2 名仅在升级为 80 或 100mg/kg/天的高剂量后才完全停止发作。当与其他抗癫痫药物联合使用时，在升级为左乙拉西坦高剂量后，有 5 名新生儿中有 4 名完全停止发作。没有观察到不良反应。
对于未能对标准剂量方案做出反应的新生儿，可以考虑递增至 80-100mg/kg/天。需要进行前瞻性研究以确认这种高剂量方案的有前途的作用，并更好地阐明左乙拉西坦在新生儿惊厥中的作用。
