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NEOLEV2 – Phenobarbital vs. Levetiracetam for Neonatal Seizure

July 16, 2020

Written by Clay Smith

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Phenobarbital was more effective than levetiracetam for controlling neonatal seizure but had more side effects.

Why does this matter?
Phenobarbital and phenytoin are often used for neonatal seizures. There is no FDA approved drug. Levetiracetam may be safer, but does it work?

NEOLEV2 – neonatal seizure control
A total of 83 patients were randomized, 30 to phenobarbital and 53 to levetiracetam. For the primary outcome of seizure-free status for 24 hours on EEG, 24/30 (80%) achieved this in the phenobarbital group vs. only 15/53 (28%) in the levetiracetam group, RR 0.35 (95%CI 0.22 to 0.56). Levetiracetam was slightly more effective at a 60mg/kg vs 40 mg/kg dose. More side effects were seen with phenobarbital, mainly hypotension, respiratory depression, and sedation. Post-hoc analysis found 24-hour seizure-free rate with bedside exam by the neurologist was 83% with phenobarbital and 36% with levetiracetam. It seems clinically and on EEG, that phenobarbital is superior to levetiracetam for controlling neonatal seizures.

Levetiracetam Versus Phenobarbital for Neonatal Seizures: A Randomized Controlled Trial. Pediatrics. 2020 Jun;145(6). pii: e20193182. doi: 10.1542/peds.2019-3182. Epub 2020 May 8.

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