Levetiracetam versus valproate for new-onset or previously treated but inadequately controlled epilepsy in children: a systematic review and meta-analysis of randomized controlled trials.
Abdullah M Alharran, Khaled M Alsaleeli, Ahmed S Alkhamis et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared levetiracetam with valproate in children aged 0–18 years with new-onset or inadequately controlled epilepsy. Eight randomized controlled trials involving 1,000 participants were included. Seizure freedom did not differ significantly between treatments (5 studies, 655 participants; RR = 0.95, 95% CI: 0.83-1.09; P = 0.45; I² = 59.5%; low-certainty evidence). Exploratory time-related outcomes favored valproate, while levetiracetam was associated with fewer overall adverse events and less weight gain. Behavioral and hepatic safety remained uncertain.
Key findings
- Seizure freedom did not differ significantly: RR = 0.95, 95% CI: 0.83-1.09; P = 0.45; low-certainty evidence.
- Exploratory survival-time and time-to-recurrence outcomes favored valproate, but evidence was low certainty and censoring was inadequately handled.
- Levetiracetam was associated with fewer overall adverse events and less weight gain.
- Levetiracetam was associated with lower AST levels, but this did not establish superior hepatic safety.
Why it matters
The findings suggest that seizure-freedom evidence alone does not clearly distinguish these medicines in children, while adverse-event profiles may differ. However, uncertainty in the evidence—particularly for time-related outcomes and behavioral and hepatic safety—means comparative benefits should be interpreted cautiously rather than treated as definitive.
What to keep in mind
The seizure-freedom evidence was low certainty and sensitive to one trial. Exploratory time-related analyses were limited by inadequate handling of censoring; behavioral and hepatic safety remained uncertain.