This systematic review and meta-analysis aims to assess the effect of levetiracetam monotherapy on thyroid function among children with epilepsy after 6 and 12 months of treatment.

Levetiracetam (LEV) is a novel antiepileptic drug (AED) used to treat partial and generalized seizures. Studies have reported that conventional AEDs alter thyroid hormone levels, while newer AEDs, including levetiracetam, have few side effects and a low potential for interaction with other anticonvulsants. Although clinical trials have demonstrated a wide safety margin, there is still limited information regarding the impact of long-term use of LEV on thyroid function, despite its increasing use.

A systematic literature search was conducted across several databases, including PubMed, Scopus, Web of Science, and Science Direct, covering studies from inception to October 2024. We included observational studies reporting thyroid hormone levels (TSH, T3, T4, FT4) in epilepsy children receiving levetiracetam (LEV) monotherapy. The pooled mean difference was calculated using both fixed and random-effects models, with a 95% confidence interval (CI) and a significance threshold set at 0.05. The I² test was used to assess heterogeneity. Statistical analysis was performed using RevMan 5.4 software.

Eight studies were finally included in this meta-analysis, encompassing 226 patients. No significant difference was found in TSH levels between baseline and at 6 and 12 months (MD = 0.08 [95% CI: -0.04, 0.20], P = 0.20). Additionally, no significant difference was found in FT4 levels between baseline and 6 months (MD = 0.05 [95% CI: -0.10, 0.20], P = 0.62). However, a significant increase was observed at 12 months (MD = 0.36 [95% CI: 0.02, 0.71], P = 0.04).

levetiracetam, monotherapy in children, does not significantly alter TSH or FT4 levels at 6 months. However, an increase in FT4 was observed at 12 months, suggesting a potential long-term effect on thyroid function for further investigation.