High neonatal seizure burden is associated with worsened neurodevelopmental outcomes. We compared the efficacy of initial treatment with levetiracetam vs phenobarbital for maintaining low seizure burden in a retrospective cohort of 25 neonates monitored with video electroencephalography (EEG). Video EEG tracing were reviewed and paired with medication bolus times to determine seizure burden after treatment. Initial cumulative dose of phenobarbital was 20 mg/kg in all but 1 case; initial cumulative dose of levetiracetam ranged from 50 to 100 mg/kg. Eleven of 17 (65%) patients sustained seizure burden <10% following initial treatment with levetiracetam, compared with 5 of 8 (63%) with phenobarbital. Thirteen (76%) patients treated with levetiracetam had sustained seizure burden <20% compared with 6 (75%) treated with phenobarbital. The phenobarbital group showed a larger absolute reduction in average seizure burden in the hour before and after treatment (−24.3 vs −14.2 minutes/h). Six of 17 (35%) patients treated with levetiracetam remained seizure free after initial treatment, compared with 2 of 8 (25%) patients treated with phenobarbital. Initial treatment with levetiracetam was associated with shorter average time to seizure freedom (15 vs 21 hours). None of these results were statistically significant. Cumulative doses of levetiracetam 100 mg/kg were well tolerated and associated with substantial decrease in seizure burden in several cases. Levetiracetam remains a promising first-line treatment for neonatal seizures; additional randomized controlled trials evaluating the effects of high-dose levetiracetam on seizure burden and long-term outcomes are warranted.

中文翻译：

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左乙拉西坦和苯巴比妥作为新生儿惊厥一线治疗的疗效

新生儿癫痫发作负担高与神经发育结果恶化有关。我们在一个由视频脑电图 (EEG) 监测的 25 名新生儿的回顾性队列中比较了左乙拉西坦与苯巴比妥初始治疗在维持低癫痫发作负担方面的疗效。视频脑电图追踪被审查并与药物推注时间配对，以确定治疗后的癫痫发作负担。苯巴比妥的初始累积剂量为 20 mg/kg，仅 1 例；左乙拉西坦的初始累积剂量范围为 50 至 100 mg/kg。17 名患者中有 11 名 (65%) 患者在接受左乙拉西坦初始治疗后癫痫发作负担小于 10%，而 8 名患者中有 5 名 (63%) 接受苯巴比妥治疗。13 名 (76%) 接受左乙拉西坦治疗的患者持续癫痫发作负担<20%，而 6 名 (75%) 接受苯巴比妥治疗的患者。苯巴比妥组在治疗前后一小时的平均癫痫发作负荷绝对减少幅度更大（-24.3 vs -14.2 分钟/小时）。接受左乙拉西坦治疗的 17 名患者中有 6 名（35%）在初始治疗后仍然没有癫痫发作，而接受苯巴比妥治疗的 8 名患者中有 2 名（25%）。左乙拉西坦初始治疗与更短的平均无癫痫发作时间相关（15 小时 vs 21 小时）。这些结果都没有统计学意义。左乙拉西坦 100 mg/kg 的累积剂量具有良好的耐受性，并且在一些病例中与癫痫发作负担的显着降低有关。左乙拉西坦仍然是新生儿癫痫发作的一线治疗药物；有必要进行额外的随机对照试验，评估高剂量左乙拉西坦对癫痫发作负担和长期结果的影响。