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Use of Intravenous Levetiracetam for Management of Acute Seizures in Neonates

  • Owais Khan
    Affiliations
    Department of Pediatrics, Children's Hospital at Scott and White Scott, and White Memorial Hospital and Texas A&M Health Science Center College of Medicine, Temple, Texas
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  • Esther Chang
    Affiliations
    Department of Pharmacy, Children's Hospital at Scott and White Scott, and White Memorial Hospital and Texas A&M Health Science Center College of Medicine, Temple, Texas
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  • Cheryl Cipriani
    Affiliations
    Department of Pediatrics, Children's Hospital at Scott and White Scott, and White Memorial Hospital and Texas A&M Health Science Center College of Medicine, Temple, Texas
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  • Chanin Wright
    Affiliations
    Department of Pharmacy, Children's Hospital at Scott and White Scott, and White Memorial Hospital and Texas A&M Health Science Center College of Medicine, Temple, Texas
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  • Edwin Crisp
    Affiliations
    Department of Neurology, Scott and White Epilepsy Center, Scott and White Neuroscience Institute, Scott and White Memorial Hospital and Texas A&M Health Science Center College of Medicine, Temple, Texas
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  • Batool Kirmani
    Correspondence
    Communications should be addressed to: Dr. Kirmani; Department of Neurology; Scott and White Epilepsy Center, Scott and White Neuroscience Institute; Scott and White Memorial Hospital and Texas A&M Health Science Center College of Medicine; 2401 South 31st Street; Temple, TX 76508.
    Affiliations
    Department of Neurology, Scott and White Epilepsy Center, Scott and White Neuroscience Institute, Scott and White Memorial Hospital and Texas A&M Health Science Center College of Medicine, Temple, Texas
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      Antiepileptic drugs used for the treatment of neonatal seizures have limited efficacy and undesirable side effects, leading to increased off-label use in neonates. Intravenous levetiracetam became available in August 2006 for use in patients above 16 years of age. Insufficient data are available about the efficacy and safety of intravenous levetiracetam in neonates. Data captured from our institution's electronic medical records were retrospectively analyzed for neonates treated with intravenous levetiracetam between January 2007 and December 2009. Data were acquired by reviewing our electronic medical records. Twenty-two patients received a levetiracetam load of 10-50 mg/kg for neonatal seizures. Nineteen of 22 patients (86%) demonstrated immediate seizure cessation at 1 hour. Seven of 22 patients (32%) achieved complete seizure cessation after administration of the loading dose, 14 (64%) achieved seizure cessation by 24 hours, 19 (86%) by 48 hours, and all 22 (100%) by 72 hours. No serious side effects were evident. Nineteen patients (86%) were discharged on oral levetiracetam, and only two patients (9%) were discharged with an additional oral antiepileptic drug. Intravenous levetiracetam can be used as monotherapy and adjunctively in acute seizure management during the neonatal period.
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