Authors
Zahabia Adnan, Amna Amir Jalal, Abdullah Hameed, Syed Hassan Ali, Shanza Shakir, Syed Ibad Hussain, Eisha Abid, Ahmed Asad Raza
Published in
The Annals of pharmacotherapy. Pages 10600280261471544. Aug 13, 2026. Epub Aug 13, 2026.
Abstract
To compare the efficacy and safety of levetiracetam versus sodium valproate as antiseizure therapy in children with new-onset epilepsy or established status epilepticus.
PubMed, Cochrane Library, Embase, and Scopus were searched from inception to March 2026, without language restriction, using combinations of "epilepsy," "status epilepticus," "pediatric," "levetiracetam," and "sodium valproate," with hand-searching of reference lists.
Randomized controlled trials and cohort studies of levetiracetam versus sodium valproate in children (≤18 years) were eligible. Two reviewers independently screened records, extracted data, and appraised quality (Cochrane RoB 2; Newcastle-Ottawa Scale for the cohort study). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects Mantel-Haenszel model, with certainty graded by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Eight studies (7 randomized trials and 1 prospective cohort) were included. Levetiracetam and sodium valproate were comparably effective for seizure freedom (RR = 1.01; 95% CI = 0.93-1.10) and for failure to achieve seizure freedom (RR = 1.00; 95% CI = 0.73-1.36). Levetiracetam significantly reduced overall AEs (RR = 0.78; 95% CI = 0.68-0.89) and weight gain (RR = 0.22; 95% CI = 0.10-0.46), both high certainty. Behavioral changes (RR = 2.15; 95% CI = 0.81-5.70) and skin rash (RR = 1.01; 95% CI = 0.50-2.04) did not differ significantly.
This is among the first meta-analyses to pool pediatric data for these agents across both new-onset epilepsy and status epilepticus and to grade outcome certainty. The findings support levetiracetam as a preferred initial monotherapy when weight, tolerability, reproductive safety, or interaction risk is a priority, with behavioral monitoring during use.
Levetiracetam and sodium valproate offer similar seizure control in pediatric epilepsy and status epilepticus, but levetiracetam has a more favorable safety profile, particularly for adverse effects and weight gain. High-quality pediatric trials with longer follow-up are needed to confirm the long-term efficacy.
PMID:
42596100
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.
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