Efficacy of Phenobarbital Versus Levetiracetam in Neonatal Seizures: Impact on EEG Results and Clinical Recovery

Background: This study compared the efficacy of phenobarbital and levetiracetam in the treatment of neonatal seizures, with emphasis on seizure control, electroencephalographic (EEG) normalization, and neurodevelopmental outcomes. Methods: A retrospective cross-sectional study was conducted in neonatal intensive care units (NICUs) in Medan, Indonesia, between January ۲۰۲۲ and February ۲۰۲۵. Neonates aged ۰–۲۸ days with clinically or EEG-confirmed seizures were included. Patients received phenobarbital, levetiracetam, or combination therapy. Outcomes assessed were seizure control within ۲۴ hours, EEG normalization during follow-up, and neurodevelopmental status. Normality of continuous data was assessed using the Shapiro–Wilk test; appropriate parametric or non-parametric tests were applied. Results: Fifty-nine neonates met the inclusion criteria: levetiracetam monotherapy (n=۳۶), phenobarbital monotherapy (n=۷), and combination therapy (n=۱۶). Seizure cessation within ۲۴ hours was achieved in ۹۴.۶% overall and ۱۰۰% in the levetiracetam group. EEG normalization occurred in ۵۸.۳% of the levetiracetam group, ۴۲.۹% of the phenobarbital group, and ۴۳.۸% of the combination group (p=۰.۵۳۷). At follow-up, all neonates in the levetiracetam group demonstrated normal neurodevelopment, compared with ۸۸.۹% in the phenobarbital group and ۸۷.۵% in the combination group. Early initiation of therapy (<۶ hours from seizure onset) was significantly associated with improved seizure control (p=۰.۰۰۸). Conclusion: Levetiracetam was as effective as phenobarbital in seizure control and EEG normalization, with a trend toward superior neurodevelopmental outcomes. These findings, derived from a Southeast Asian NICU setting, support levetiracetam as a safe and effective first-line agent for neonatal seizures. Early initiation of therapy and structured EEG monitoring further improve prognostication and outcomes.

کلیدواژه ها:

EEG normalization ، Levetiracetam ، neonatal seizures ، Neurodevelopmental outcome ، Phenobarbital