title: Levetiracetam increases neonatal hypoxic-ischemic brain injury under normothermic, but not hypothermic conditions.
abstract: BACKGROUND
  Hypoxic-ischemic encephalopathy (HIE) resulting from perinatal asphyxia often leads to severe neurologic impairment or even death. There is a need to advance therapy for infants with HIE, for example to combine hypothermia with pharmacological treatment strategies. Levetiracetam (LEV) is approved for clinical administration to infants older than 4 weeks of age and is also used off-label in neonates. Furthermore, LEV was shown to be neuroprotective in adult animal models of brain injury.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the neuroprotective potential of LEV in vitro using primary hippocampal neurons, and in vivo using an established model of neonatal hypoxic-ischemic brain injury.
  
  
  RESULTS
  LEV treatment per se did not induce neurotoxicity in the developing rodent brain. Following oxygen glucose deprivation, we observed some, although not a significant, increase in cell death after LEV treatment. In vivo, LEV was administered under normothermic and hypothermic conditions following hypoxic-ischemic brain damage. LEV administration significantly increased brain injury under normothermic conditions. Compared to the normothermia-treated group, in the hypothermia group LEV administration did not increase hypoxic-ischemic brain injury.
  
  
  CONCLUSIONS
  This study demonstrates that LEV treatment increases neonatal hypoxic-ischemic brain injury. Administration of LEV in the acute phase of the injury might interfere with the balanced activation and inactivation of excitatory and inhibitory receptors in the developing brain. The neurotoxic effect of LEV in the injured newborn brain might further suggest an agonistic effect of LEV on the GABAergic system. Hypothermia treatment attenuates glutamate release following hypoxic-ischemic brain injury and might therefore limit the potentially deleterious effects of LEV. As a consequence, our findings do not necessarily rule out a potentially beneficial effect, but argue for cautious use of LEV in newborn infants with pre-existing brain injury.
authors: Department of Pediatrics II, Innsbruck Medical University, Austria. Electronic address: Elke.Griesmaier@i-med.ac.at.
authors: Elke
authors: E
authors: Griesmaier
authors: Department of Pediatrics II, Innsbruck Medical University, Austria.
authors: Katharina
authors: K
authors: Stock
authors: Department of Pediatrics II, Innsbruck Medical University, Austria; Division of Experimental Dermatology and Eb House, Paracelsus Medical University, Salzburg, Austria.
authors: Katharina
authors: K
authors: Medek
authors: Department of Physiology and Medical Physics, Innsbruck Medical University, Austria.
authors: Ruslan I
authors: RI
authors: Stanika
authors: Department of Physiology and Medical Physics, Innsbruck Medical University, Austria.
authors: Gerald J
authors: GJ
authors: Obermair
authors: Department of Pediatrics II, Innsbruck Medical University, Austria.
authors: Anna
authors: A
authors: Posod
authors: Department of Pediatrics II, Innsbruck Medical University, Austria.
authors: Karina
authors: K
authors: Wegleiter
authors: Department of Pediatrics II, Innsbruck Medical University, Austria.
authors: Martina
authors: M
authors: Urbanek
authors: Department of Pediatrics II, Innsbruck Medical University, Austria.
authors: Ursula
authors: U
authors: Kiechl-Kohlendorfer
mesh_terms: D000818:Animals; D051033:Apoptosis Inducing Factor / Q000378:metabolism; D053148:Caspase 3 / Q000378:metabolism; D002452:Cell Count; D016923:Cell Death / Q000187:drug effects; D002478:Cells, Cultured; D002540:Cerebral Cortex / Q000187:drug effects / Q000473:pathology; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004622:Embryo, Mammalian; D005786:Gene Expression Regulation / Q000187:drug effects; D005947:Glucose / Q000172:deficiency; D006624:Hippocampus / Q000166:cytology; D007036:Hypothermia, Induced / Q000379:methods*; D000860:Hypoxia; D020925:Hypoxia-Ischemia, Brain / Q000139:chemically induced / Q000188:drug therapy*; D000077287:Levetiracetam; D051379:Mice; D009474:Neurons / Q000187:drug effects; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D051033:Apoptosis Inducing Factor; D018696:Neuroprotective Agents; D000077287:Levetiracetam; D053148:Caspase 3; D005947:Glucose; D010889:Piracetam
keywords: Brain; Hypothermia; Hypoxic-ischemic brain injury; Levetiracetam; Neurotoxic; Newborn