Objective To systematically review the efficacy and safety of sodium valproate versus levetiracetam in the treatment of pediatric epilepsy.

Methods  PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, VIP, WanFang Data and SinoMed databases were electronically searched for randomized controlled trials (RCTs) of sodium valproate (experimental group) versus levetiracetam (control group) in the treatment of pediatric epilepsy from inception to June 26th, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, Meta analysis was performed by using RevMan 5.4.1 software.

Results  A total of 14 RCTs involving 1 219 patients were included. The results of Meta-analysis showed that the effective rate of levetiracetam in the treatment of pediatric epilepsy was higher than that of sodium valproate, but the difference was not statistically significant (RR=0.96, 95%CI 0.90 to 1.02, P=0.20). The total incidence of adverse reactions of levetiracetam was lower than that of sodium valproate, with statistically significant difference (RR=1.40, 95%CI 1.08 to 1.81, P=0.01), and sodium valproate was more prone to abnormal liver function, and the difference was statistically significant compared with levetiraletam (RR=7.00, 95%CI 2.12 to 23.12, P=0.001).

Conclusion  Current evidence suggests that both sodium valproate and levetiracetam have good efficacy in the treatment of pediatric epilepsy, but the safety of levetiracetam in the treatment of pediatric epilepsy is higher than that of valproate, and the incidence of liver damage of sodium valproate is higher, so the liver function of children using the drug should be paid close attention to clinically. Due to the limitations of the quantity and quality of included studies, more large-sample, multi-center and high-quality studies are required to verify the above conclusions.

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