Iranian Journal of Neonatology

Iranian Journal of Neonatology

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

Document Type : Original Article

Authors
Bugis Mardina Lubis 1
Johannes Harlan Saing 1
Christa Martha Novita Pardede 2
1 1. Department of Pediatrics, Faculty of Medicine, Universities Sumatera Utara, Medan, Indonesia 2. Department of Pediatrics, Stella Maris Mother and Children Hospital, Medan, Indonesia
2 Department of Pediatrics, Stella Maris Mother and Children Hospital, Medan, Indonesia
10.22038/ijn.2026.89357.2730
Abstract
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 2022 and February 2025. Neonates aged 0–28 days with clinically or EEG-confirmed seizures were included. Patients received phenobarbital, levetiracetam, or combination therapy. Outcomes assessed were seizure control within 24 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=36), phenobarbital monotherapy (n=7), and combination therapy (n=16). Seizure cessation within 24 hours was achieved in 94.6% overall and 100% in the levetiracetam group. EEG normalization occurred in 58.3% of the levetiracetam group, 42.9% of the phenobarbital group, and 43.8% of the combination group (p=0.537). At follow-up, all neonates in the levetiracetam group demonstrated normal neurodevelopment, compared with 88.9% in the phenobarbital group and 87.5% in the combination group. Early initiation of therapy (<6 hours from seizure onset) was significantly associated with improved seizure control (p=0.008).
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.
Keywords
EEG normalization
Levetiracetam
Neonatal seizures
Neurodevelopmental outcome
Phenobarbital
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Iranian Journal of Neonatology
Volume 17, Issue 3
Summer 2026
Pages 9-15