We thank the reader for critically evaluating our research study [1]. The queries raised are addressed below:

Video EEG was not done in our study and we have already mentioned it as a study limitation, and the same has also been highlighted in the accompanying editorial [1,2]. We agree that most neonatal seizures are symptomatic and do not require long-term medications. Our objective was to find out short-term outcome, and it was expected that randomization would have overcome any bias due to spontaneous seizure resolution or resolution due to medications, as it applies for both groups.

Following first dose of levetiracetam (LEV), seizures stopped in 30 (60%) neonates and following second dose, seizures stopped in 43 (86%) in our study [1]. The dose of LEV is not established in neonates and, we used a dose based on published studies, evidence available from off-label use, and our experience. The phase 2b randomized controlled study (NEOLEV2) was published after our study was completed [3]. As there are studies showing that both phenobarbitone (PB) and LEV are equally effective but LEV has lesser side-effects, we need more studies to find a definite answer in this regard.

Our study is on neonatal seizures in general and not specific to hypoxic ischemic encephalopathy (HIE), that may be the reason for mean age being 8-9 days. None of our newborns received therapeutic hypothermia. We have proposed levetiracetam as an effective and safer alternative to phenobarbitone as a first line drug in neonatal seizures, and not in neonates with HIE [1]. We agree about the need for long term studies to look for neurodevelopmental outcome of these neonates, and the same has been acknowledged already as a limitation of our study.

1. Gowda VK, Romana A, Shivanna NH, Benakappa N, Benakappa A. Levetiracetam versus phenobarbitone in neonatal seizures – A randomized controlled trial. Indian Pediatr. 2019;56:643-6.

2. Swami M, Kaushik JS. Levetiracetam in neonatal seizures. Indian Pediatr.2019; 56:639-40.