Journal of Pediatric Neurosciences
: 2018  |  Volume : 13  |  Issue : 4  |  Page : 520--521

Correspondence to levetiracetam in neonatal seizures as first-line treatment

Raffaele Falsaperla, Giovanna Vitaliti 
 Department of Paediatrics, General Paediatrics Operative Unit, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania, Italy

Correspondence Address:
Prof. Raffaele Falsaperla
Unit of Pediatrics and Pediatric Emergency, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania

How to cite this article:
Falsaperla R, Vitaliti G. Correspondence to levetiracetam in neonatal seizures as first-line treatment.J Pediatr Neurosci 2018;13:520-521

How to cite this URL:
Falsaperla R, Vitaliti G. Correspondence to levetiracetam in neonatal seizures as first-line treatment. J Pediatr Neurosci [serial online] 2018 [cited 2020 Sep 18 ];13:520-521
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Full Text

Dear Editor

We read with interest the comments by Mandal and Sahi[1] on our paper entitled: “Levetiracetam in neonatal seizures as first-line treatment: a prospective study”[2] and we would like to clarify those questions addressed to our paper.

Considering the literature data on the use of phenobarbital in neonates and its adverse effects as proapoptotic agent,[2] the main aim of our study was to demonstrate the efficacy and safe profile of levetiracetam in the treatment of neonatal seizures. In this regard, levetiracetam has got a safer profile than phenobarbital, considering its neuroprotective action, and it was used safely as a first-line treatment in our neonates, replacing the standard use of phenobarbital.

As far as the abstract is concerned, the study period refers from July 2015 to July 2016 (1 year of follow-up). There was a typing error in the abstract.

As far as the methods section is concerned, in our study, we included all patients with seizures. Nevertheless, as Mandal and Sahi should know, children with hypoxic–ischemic disease may present subclinical seizures called “autonomic seizures,” a subgroup of subtle seizures, which may be evident neither on clinical evaluation nor on electroencephalography (EEG). This is the reason why we detailed this group of patients.

Moreover, the inclusion in our study was consecutive and casual. This kind of sampling did not give us any bias limits because the sample was not accurately selected as the authors are accusing in their letter. An accurate selection of patients would have given targeted results, and this was not our intent. In our study, all patients with seizures during the study period were treated with levetiracetam as a first-line anticonvulsant agent.

In Figure 2, tonic–clonic seizures do not represent an electroencephalographic diagnosis but only a clinical diagnosis. This diagnosis was performed on a clinical basis alone by neonatologists of our neonatal intensive care unit. Figure 2 explains that among 50% of patients with clinically evident tonic–clonic seizures, results from interictal EEG showed 12.5% delta brushes, 12.5% cortical nonspecific sufferance, and 25% centrotemporal spikes. The figure is explained in detail in the text. We suggest the editor to detail this explanation in the Figure 2 legend, to avoid further misunderstanding.

As far as results of magnetic resonance imaging (MRI) are concerned, we detailed that “approximately” 40% of patients had a positive MRI, to stress that less than a half had brain cerebral diseases.

No subtle seizures were evidenced because they are usually difficult to detect both on a clinical point of view and on an electroencephalographic point of view, and they often require a very long EEG monitoring to be detected. We only reported clinical seizures as described by our neonatologists on clinical evidence. And in our study, our neonatologists did not detect any subtle seizures. Moreover, we reported only intercritical EEGs because we only could detect critical events in two patients.

We hope that these details can improve the reading of our paper. We also thank Mandal and Sahi for the interest they showed in our paper, suggesting further clinical trials to reinforce the results we described in our paper.

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 Conflicts of interest

There are no conflicts of interest.


1Mandal A, Sahi PK. Levetiracetam as a first-line agent for neonatal seizure. J Pediatr Neurosci 2017;12:395-6.
2Falsaperla R, Vitaliti G, Mauceri L, Romano C, Pavone P, Motamed-Gorji N, et al. Levetiracetam in neonatal seizures as first-line treatment: a prospective study. J Pediatr Neurosci 2017;12:24-8.