Phenobarbital and Levetiracetam frontline drugs to control neonatal seizures, finds study

In a new study conducted by Zhen-E Xu and team, it was found that Phenobarbital is recommended as the first-line treatment for newborn seizures. Furthermore, levetiracetam appears to be an effective second-line therapy for newborn seizures once first-line medicines fail.

The findings of this study were published in the Journal Pediatrics & Neonatology.

Anti-epileptic medications have varying effects on newborn seizures, and novel treatments have become widely utilized in recent years. Meanwhile, there are still considerable disparities in the management of newborn seizures, whether in terms of medication choice or length of treatment. And, as therapy choices have expanded, the optimal choice of second-line treatment has not been advised.

The databases MEDLINE, the Cochrane Library, Web of Science, Embase, and clinicaltrials.gov were searched for this study (January 1, 1960 to October 20, 2020). We chose randomized controlled trials (RCTs) or observational studies on anti-epileptic medications for newborn seizures. The researchers then performed a network meta-analysis to compare the effectiveness of first-line and second-line anti-epileptic medications for newborn seizures.

The results were stated as follow:

1. The databases MEDLINE, the Cochrane Library, Web of Science, Embase, and clinicaltrials.gov were searched for this study (January 1, 1960 to October 20, 2020).

2. Researchers chose randomized controlled trials (RCTs) or observational studies on anti-epileptic medications for newborn seizures.

3. The team then performed a network meta-analysis to compare the effectiveness of first-line and second-line anti-epileptic medications for newborn seizures.

4. According to the statistics, phenobarbital was more successful as a first-line therapy than levetiracetam and phenytoin.

5. When administered as a second-line treatment, phenobarbital was more effective than any other medicine.

6. At the same time, midazolam was shown to be more effective than lidocaine in suppressing seizures.

7. In terms of secondary results, levetiracetam is less likely than phenobarbital to have long-term deleterious consequences in newborns.

Because more credible data are lacking, phenobarbital is advised as the first-line therapy for newborn seizures, taking into account available factors such as effectiveness, toxicity, and adverse effects. Furthermore, independent of effectiveness or mortality rate, phenytoin performed better as a first-line treatment than all other medicines except phenobarbital. Furthermore, levetiracetam appears to be an effective second-line therapy for newborn seizures once first-line medicines fail. In conclusion, the quality of our study is inadequate due to a lack of appropriate RCTs and other factors. As a result, larger, more standardized, and long-term investigations are necessary.

Reference:

Xu, Z.-E., Li, W.-B., Qiao, M.-Y., Cui, H.-T., Zhao, L.-Z., Chen, Q.-X., & Miao, J.-K. (2021). Comparative efficacy of anti-epileptic drugs for neonatal seizures: A network meta-analysis. In Pediatrics & Neonatology (Vol. 62, Issue 6, pp. 598–605). Elsevier BV. https://doi.org/10.1016/j.pedneo.2021.06.005