Phenobarbitone versus levetiracetam in neonatal seizures

Ravindra Kumar Jain, Hemant Kumar


Background: There is increasing evidence that neonatal seizures have an adverse effect on neurodevelopmental progression and it may predispose to cognitive, behavioral or epileptic complications later in life. The objective of this study was to compare the efficacy of phenobarbitone and levetiracetam for the treatment of neonatal seizures in term and late preterm neonates. The study was aimed to know the efficacy of phenobarbitone (PB) in comparison with levetiracetam (LEV) in controlling neonatal seizures.

Methods: This was a randomized controlled trial where data of the babies with seizures weighing more than 2 kg who were admitted in NICU of Muzaffarnagar Medical College was collected and analysed for intervention to either phenobarbitone or levetiracetam.

Results: Clinically apparent seizures were controlled in only 65.38% neonates assigned to receive levetiracetam as compared to 76.92% neonates assigned to receive phenobarbitone.

Conclusions: LEV although lesser effective than PB with very fewer side effects is found to be a good alternative in controlling neonatal seizures.


Levetiracetam, Neonatal seizures, Phenobarbitone

Full Text:



Volpee JJ. Neonatal seizures. In: Neurology of the neoborns. 4th ed. Philadelphia, PA: WB Saunders; 2001:178-214.

van Rooij LG, van den Broek MP, Rademaker CM, de Vries LS. Clinical management of seizures in newborns: diagnosis and treatment. Paediatr Drugs. 2013;15(1)9-18.

Tekgul H, Gauvreau K, Soul J, Murphy L, Robertson R, Stewart J, et al. The current etiologic profile and neurodevelopmental outcome of seizure in term newborn infants. Paediatr. 2006;117(4):1270-80.

Bittigau P, Sifringer M, Genz K. Antiepileptic drugs and apoptotic neurodegeneration in the developing brain. Proc Natl Acad Sci USA. 2002;99:15089-94.

Merhar SL, Schibler KR, Sherwin CM, Meinzen-Derr J, Shi J, Balmakund T, et al. Pharmacokinetics of LEV in neonates with seizures. The J Pediatr. 2011;159(1):152-3.

Briggs DE, French JA. Levetiracetam safety profiles and tolerability in epilepsy patients. Expert Opin Drug Saf. 2004;3(5):415-24.

Sharpe CM, Capparelli EV, Mower A, Farrell MJ, Soldin SJ, Haas RH. A seven-day study of pharmacokinetics of intravenous levetiracetam in neonates:marked changes in pharmacokinetics occur during the first week of life. Pediatr Res. 2012;72(1):43-9.

Han JY, Moon CJ, Youn YA, Sung IK, Lee IG. Efficacy of Levetiracetam for neonatal seizures in preterm infants. BMC Pediatr. 2018;18:131.

Ramantani G, Ikonomidou C, Walter B, Rating D, Dinger J. Leveratiracetam: safety and efficacy in neonatal seizures. Eur J Paediatr Neurol. 2011;15:1-7.

Khan O, Chang E, Cipriani C, Wright C, Crisp E, Kirmani B. Use of intravenous levetiracetam for management of acute seizures in neonates. Pediatr Neurol. 2011;44:265-9.

Abend NS, Gutierrez-Colina AM, Monk HM, Dlugos DJ, Clancy RR. Levetiracetam for treatment of neonatal seizures. J Child Neurol. 2011;26:465-70.

McHugh DC, Lancaster S, Manganas LN. A systematic review of the efficacy of levetiracetam in neonatal seizures. Neuropediatr. 2018;49:12-7.

Rakshasbhuvankar A, Rao S, Kohan R, Simmer K, Nagarajan L. Intravenous levetiracetam for treatment of neonatal seizures. J Clin Neurosci. 2013;20(8):1165-7.

Shoemaker MT, Rotenberg JS. Levetiracetam for the treatment of neonatal seizures. J Child Neurol. 2007;22:95-8.

Shoemaker MT, Rotenberg JS. Safety and tolerability of levetiracetam in infants. Epilepsia. 2005;46:160.

Blonk MI, van der Nagel BC, Smit LS, Mathot RA. Quantification of levetiracetam in plasma of neonates by ultra-performance liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2010;878:675-81.

Pathak G, Upadhyay A, Pathak U, Chawla D, Goel SP. Phenobarbitone and phenytoin for treatment of neonatal seizures: open-label randomized controlled trial. Indian Pediatr. 2013;50:753-58.

Sahaya K, Goyal MK, Sarwal A, Singh NN. Levetiracetam-induced thrombocytopenia among inpatients: a retrospective study. Epilepsia. 2010;51:2492-5.

Sethi NK, Sethi PK, Torgovnick J, Arsura E, Cukierwar F. Asymptomatic elevation of liver enzymes due to levetiracetam: a case report. Drug Metabol Drug Interact. 2013;28(2):123-4.

Koklu E, Ariguloglu EA, Koklu S. Levetiracetam-induced anaphylaxis in a neonate. Pediatr Neurol. 2014 Feb 1;50(2):192-4.