The Risk of Withdrawal Seizures & Other Adverse Events in Newborns Associated with Levetiracetam Use as Monotherapy or in Combination Therapy for Seizures During Pregnancy - A Systematic Review View PDF

*Akshitha Palabindela
Department Of Medicine, RVM Institute Of Medical Sciences And Research Center, Siddipet, Telangana, India

*Corresponding Author:
Akshitha Palabindela
Department Of Medicine, RVM Institute Of Medical Sciences And Research Center, Siddipet, Telangana, India
Email:akshithapalabindela@gmail.com

Published on: 2023-05-15

Abstract

Introduction: Epilepsy is a neurological disorder that can affect pregnant women, and the use of anti-epileptic drugs during pregnancy must be carefully evaluated. This systematic review aims to assess the risk of withdrawal seizures and other adverse events in newborns when pregnant women with seizures are treated with levetiracetam compared to other treatments.
Methods: Multiple online scientific databases including PubMed, PubMed Central, Ovid MEDLINE, CINAHL, the Cochrane Central Register of Controlled Trials, Web of Knowledge, PsycINFO, and Scopus. The studies were chosen based on the developed inclusion and exclusion criteria. The quality of articles retrieved was assessed by the Robins I-tool for non-randomized trials and a standard Excel data extraction sheet was used to extract data from relevant studies.
Results & Discussion: Out of the 211 studies obtained from database searches and registers, only 11 met the inclusion criteria and were included in this systematic review. A total of 4726 patients were included in this systematic review. The studies were from different geographical regions and countries. The study found that AED polytherapy increased the risk of adverse pregnancy outcomes, including congenital malformations, intrauterine growth restriction, and preterm delivery, and recommended the use of AED monotherapy whenever possible to minimize these risks. Levetiracetam was found to be a safe alternative to other AEDs during pregnancy. The study also established the safety of AED use during lactation, but monitoring of AED levels is essential.
Conclusion: Levetiracetam and other AEDs as monotherapy treatment during pregnancy are generally safe and effective for women with epilepsy. AED polytherapy should be avoided, and treatment choices should be individualized to minimize adverse events.

Keywords

Epilepsy; Neurological Disorder; AED Monotherapy; Levetiracetam

Introduction

Epilepsy is a central nervous system disorder characterized by way of abnormally high electric impulses produced by neurons, resulting in involuntary body movements, abnormal behavior, loss of awareness, and altered memory [1]. Various factors can cause epilepsy, including cerebral stroke, mind tumors, head injuries, hypoxic damage, infections, metabolic diseases, storage diseases, hormonal imbalances, and substance abuse [2].
Anti-epileptic medications are available to control unusual impulses and prevent seizure episodes. However, some of these medications can have teratogenic effects on the fetus as they cross the placental barrier. In the 1990s, newer anti-epileptic drugs were discovered that were safer for use during pregnancy. One of these drugs is levetiracetam, a second-generation anti-epileptic drug that binds to the SV2A protein found in the synaptic vesicles of neurons, preventing the release of neurotransmitters without affecting normal neurotransmission [3].
The use of anti-epileptic tablets during pregnancy is vital, as untreated seizures can damage the mom and the growing fetus. However, it’s of paramount importance to weigh the benefits and risks of treatment, specifically when it comes to the protection of the fetus. Therefore, this systematic review aims to evaluate the risk of withdrawal seizures in newborns associated with using levetiracetam as monotherapy or in aggregate remedy for seizures at some point of pregnancy, compared to different anti-epileptic capsules or placebo. Given the potential teratogenic outcomes of some anti-epileptic drugs on the fetus, it’s far crucial to evaluate the safety and efficacy of levetiracetam to be used at some stage in pregnancy to guide clinical exercise and improve maternal and fetal effects.

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