Levetiracetam Helps More Than Placebo In Childhood Epilepsy

What was studied

This study combined results from randomized controlled trials that tested levetiracetam in children and teens with epilepsy. The authors searched medical databases for trials from 2000 to August 6, 2025. They included studies of patients age 16 or younger, and also some mixed child-and-adult studies if pediatric participants were represented. In total, 25 trials with 4,070 participants were included, and 23 trials were combined in the main pooled analyses.

The review looked at whether levetiracetam was associated with seizure freedom or at least a 50% reduction in seizures. It compared levetiracetam with placebo or no added treatment, and with other antiseizure medicines. Some trials studied levetiracetam alone, while others studied it as an add-on treatment. The authors also assessed study quality and risk of bias.

What they found

Compared with placebo or no therapy, levetiracetam was associated with better seizure outcomes, mostly in add-on treatment studies. The pooled results suggested about 11% more patients became seizure-free and about 24% more had at least a 50% reduction in seizures.

Compared with other antiseizure medicines, levetiracetam did not show an overall advantage. On average, seizure freedom and responder rates were not better, and in analyses limited to lower-risk-of-bias trials, levetiracetam showed a significant disadvantage versus active comparators. Results from pediatric-only trials were similar to the overall findings.

Limits of the evidence

This review cannot show that levetiracetam is the best choice for all children with epilepsy. Many included studies had important quality concerns: 14 of the 25 trials were judged at high risk of bias.

The studies were also quite different from each other, including different epilepsy types, treatment settings, comparison drugs, and follow-up lengths. Some trials included adults as well as children, so not all results come from pediatric-only groups. The authors also noted possible publication bias and limited pediatric-only comparative data.

For families and caregivers

For families, this suggests levetiracetam can improve seizure outcomes compared with placebo, especially when added to another seizure medicine. But it did not consistently work better than established seizure medicines in children, and may be less effective in some groups when higher-quality studies are considered.

This matters because levetiracetam is often used for reasons beyond seizure control alone, such as ease of administration or perceived tolerability, but this review focused on seizure outcomes. Families may want to know that a commonly used medicine does not necessarily have better seizure results than other options.

What to watch next

Stronger evidence would come from more high-quality pediatric-only trials that directly compare levetiracetam with specific other seizure medicines over similar follow-up times.

Terms in this summary

systematic review

A study that collects and summarizes all relevant research on a question using a planned method.

meta-analysis

A statistical method that combines results from multiple studies to estimate an overall effect.

randomized controlled trial

A study where participants are assigned by chance to different treatments to compare outcomes fairly.

adjunctive therapy

A treatment used in addition to another main treatment.

monotherapy

Treatment using just one medicine.

responder rate

The percentage of patients who had a meaningful improvement, here defined as at least a 50% drop in seizures.

risk of bias

The chance that study design or conduct may have made the results less reliable.