Qiao Meng-Yuan, Cui Hong-Tao, Zhao Ling-Zhi, Miao Jing-Kun, Chen Qi-Xiong
Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Neurol. 2021 Nov 18;12:747745. doi: 10.3389/fneur.2021.747745. eCollection 2021.
Neonatal seizures are a common neurological emergency in newborns. Phenobarbital (PB) is the first-line antiepileptic drug (AED). However, PB has some side effects, such as hypotension and respiratory depression, and it can accelerate neuronal apoptosis in the immature brain. Levetiracetam (LEV), a new antiepileptic drug, has been used as a second-line drug for the treatment of neonatal seizures. Compared with PB, LEV has many advantages, including a low incidence of side effects and better neurodevelopmental outcomes. However, there are only a few systematic reviews of LEV for the treatment of neonatal seizures. To evaluate the efficacy and safety of LEV for neonatal seizures and to compare the efficacy, side effects, and neurological outcomes between LEV and PB in the treatment of neonatal seizures. The keywords LEV, PB, and neonatal seizure were searched in the MEDLINE, Cochrane Library, Web of Science, EMBASE, clinicaltrials.gov, and China National Knowledge Internet (CNKI) databases with a last update in July 2021 to collect high-quality studies. We collected studies studying the efficacy or safety of LEV and PB in the treatment of neonatal seizures applying strict inclusion and exclusion criteria. The data were extracted and outcome measures, including efficacy, side effect rate, neurological score, and mortality rate, were analyzed with RevMan 5.3 software. Ten articles were finally included in the meta-analysis. The meta-analysis showed that there was no difference in efficacy between LEV and PB in the treatment of neonatal seizures. Compared with PB, the incidence of side effects of LEV was lower. The incidence of hypotension and respiratory depression in the LEV group was significantly lower than that in the PB group. In terms of long-term neurodevelopmental outcomes, there was no significant difference in the Bayley Scales of Infant Development (BSID) scores between LEV and PB. PB is still the first-line AED recommended by the WHO for the treatment of neonatal seizures. The new AEDs LEV may not have better efficacy than PB. At the same time, LEV is associated with better neurodevelopment outcomes and a lower risk of adverse effects. In addition, continuous EEG monitoring should be used to diagnose neonatal seizures to evaluate the severity of the seizures, remission, and drug efficacy. PROSPERO, identifier: CRD42021279029.
新生儿惊厥是新生儿常见的神经系统急症。苯巴比妥（PB）是一线抗癫痫药物（AED）。然而，PB有一些副作用，如低血压和呼吸抑制，并且它会加速未成熟脑内的神经元凋亡。左乙拉西坦（LEV）是一种新型抗癫痫药物，已被用作治疗新生儿惊厥的二线药物。与PB相比，LEV有许多优点，包括副作用发生率低和神经发育结局更好。然而，关于LEV治疗新生儿惊厥的系统评价较少。为了评估LEV治疗新生儿惊厥的疗效和安全性，并比较LEV与PB在治疗新生儿惊厥时的疗效、副作用及神经学结局。在MEDLINE、Cochrane图书馆、科学网、EMBASE、clinicaltrials.gov和中国知网（CNKI）数据库中检索关键词LEV、PB和新生儿惊厥，检索截至2021年7月的最新文献，以收集高质量研究。我们采用严格的纳入和排除标准收集研究LEV和PB治疗新生儿惊厥疗效或安全性的研究。提取数据并用RevMan 5.3软件分析结局指标，包括疗效、副作用发生率、神经学评分和死亡率。最终有10篇文章纳入荟萃分析。荟萃分析表明，LEV和PB治疗新生儿惊厥的疗效无差异。与PB相比，LEV的副作用发生率更低。LEV组低血压和呼吸抑制的发生率显著低于PB组。在长期神经发育结局方面，LEV和PB在贝利婴儿发育量表（BSID）评分上无显著差异。PB仍然是世界卫生组织推荐的治疗新生儿惊厥的一线AED。新型AED LEV的疗效可能并不比PB更好。同时，LEV与更好的神经发育结局和更低的不良反应风险相关。此外，应使用连续脑电图监测来诊断新生儿惊厥，以评估惊厥的严重程度、缓解情况和药物疗效。国际前瞻性系统评价注册库，标识符：CRD42021279029。
