The comparison of levetiracetam and piracetam effectiveness on breath-holding spells in children: A randomized controlled clinical trial

Document Type : Original Article

Authors

1 Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: We aimed to compare the effectiveness of Levetiracetam and Piracetam on the severity and frequency of spells in children with severe breath-holding spells (BHS), i.e. bening, paroxysmal, and nonepileptic events that are common in early childhood. Materials and Methods: This study is a randomized controlled clinical trial in 71 children from 6 months to 6 years of age with BHS. They were randomly assigned to the two study groups (Levetiracetam and Piracetam group). The frequency and severity of BHS and the response to treatment were recorded on monthly visits during our 3 months follow-up. Results: There was a significant decline in the average number of frequency of spells before and after 3 months of treatment in each group in this study. Levetiracetam had significant effects on the average incidence of the loss of consciousness and seizure-like movements in our study, while Piracetam had no significant effect on the loss of consciousness. Our result showed better response in the Levetiracetam group (88.9% partial or complete response after treatment) compared with the Piracetam group (77.1% partial or complete response after treatment); however, it was not significant. It seems that Levetiracetam had better effect than Piracetam in some aspects in the treatment of BHS. Conclusions: Both Piracetam and Levetiracetam are safe and had significant effects on the frequency of BHS in our study, however, levetiracetam showed superior effects on the severity of BHS.

Keywords

1.
Akalin F, Turan S, Güran T, Ayabakan C, Yilmaz Y. Increased QT dispersion in breath-holding spells. Acta Paediatr 2004;93:770-4.  Back to cited text no. 1
    
2.
Leung AK, Leung AA, Wong AH, Hon KL. Breath-holding spells in pediatrics: A narrative review of the current evidence. Curr Pediatr Rev 2019;15:22-9.  Back to cited text no. 2
    
3.
DiMario FJ Jr. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics 2001;107:265-9.  Back to cited text no. 3
    
4.
Movahedian AH, Heidarzadeh Arani M, Motaharizad D, Mousavi GA, Mosayebi Z. Evaluation of QT dispersion in children with breath holding spells. Iran J Child Neurol 2016;10:25-30.  Back to cited text no. 4
    
5.
Flodine TE, Mendez MD. Breath Holding Spells. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539782/; 2020.  Back to cited text no. 5
    
6.
Lukkarinen H, Virtanen I, Arikka H, Arola A, Peltola M, Ekblad H. Recurrent sinus arrest and asystole due to breath-holding spell in a toddler; Recovery with levetiracetam-therapy. Circulation 2010;122:e637.  Back to cited text no. 6
    
7.
Goldman RD. Breath-holding spells in infants. Can Fam Physician 2015;61:149-50.  Back to cited text no. 7
    
8.
Abbasi E, Ghazavi A, Hassanvand Amouzadeh M, Valizadeh M, Matinkhah M. Evaluation of the efficacy of LevetiracetamPlus Iron in comparison with iron alone in controlling and reducing the frequency of breath-holding spells in children aged 6 months to 5 years. Iran J Child Neurol 2020;14:43-53.  Back to cited text no. 8
    
9.
Nasiri J, Azimi A, Ghazavi M, Sadinejad M. Therapeutic effects of single and divided doses of piracetam for children with severe breath holding spells. J Compr Pediatr 2019;10:e69219.  Back to cited text no. 9
    
10.
Egunsola O, Choonara I, Sammons HM. Safety of levetiracetam in paediatrics: A systematic review. PLoS One 2016;11:e0149686.  Back to cited text no. 10
    
11.
Wood M, Daniels V, Provins L, Wolff C, Kaminski RM, Gillard M. Pharmacological profile of the novel antiepileptic drug candidate padsevonil: Interactions with synaptic vesicle 2 proteins and the GABA<sub>A</sub>receptor. J Pharmacol Exper Therap 2020;372:1-10.  Back to cited text no. 11
    
12.
Abbaskhanian A, Ehteshami S, Sajjadi S, Rezai MS. Effects of piracetam on pediatric breath holding spells: A randomized double blind controlled trial. Iran J Child Neurol 2012;6:9-15.  Back to cited text no. 12
    
13.
Dai AI, Demiryürek AT. Effectiveness oral theophylline, piracetam, and iron treatments in children with simple breath-holding spells. J Child Neurol 2020;35:25-30.  Back to cited text no. 13
    
14.
Ghareib BA, Khalil M, Gaber DM. A comparative study of the efficacy of using piracetam with iron therapy versus iron therapy alone in children with breath-holding spells. Alex J Pediatr 2017;30:26.  Back to cited text no. 14
  [Full text]  
15.
Rathore G, Larsen P, Fernandez C, Parakh M. Diverse presentation of breath holding spells: Two case reports with literature review. Case Rep Neurol Med 2013;2013:603190.  Back to cited text no. 15
    
16.
Azam M, Bhatti N, Shahab N. Piracetam in severe breath holding spells. Int J Psychiatry Med 2008;38:195-201.  Back to cited text no. 16
    
17.
Mattie-Luksic M, Javornisky G, DiMario FJ. Assessment of stress in mothers of children with severe breath-holding spells. Pediatrics 2000;106:1-5.  Back to cited text no. 17
    
18.
Bhat MA, Ali W, Mohidin K, Sultana M. Prospective study of severe breath holding spells and role of iron. J Pediatr Neurol 2007;5:027-32.  Back to cited text no. 18
    
19.
Breukels MA, Plötz FB, van Nieuwenhuizen O, van Diemen-Steenvoorde JA. Breath holding spells in a 3-day-old neonate: An unusual early presentation in a family with a history of breath holding spells. Neuropediatrics 2002;33:41-2.  Back to cited text no. 19
    
20.
Donma MM. Clinical efficacy of piracetam in treatment of breath-holding spells. Pediatr Neurol 1998;18:41-5.  Back to cited text no. 20
    
21.
Garg RK. Piracetam for the treatment of breath-holding spells. Indian Pediatr 1998;35:1034-5.  Back to cited text no. 21
    
22.
Ashrafi M, Mohammadi M, Badve S. Efficacy of Piracetam in treatment of breath-holding spells. Iran J Pediatr 2002;12:33-6.  Back to cited text no. 22
    
23.
Lyseng-Williamson KA. Levetiracetam: A review of its use in epilepsy. Drugs 2011;71:489-514.  Back to cited text no. 23