Levetiracetam seizure frequency, increased

Withdrawal seizure Withdraw levetiracetam gradually to minimize the potential of increased seizure frequency. 

Nervons system Two patients, one with cr)rp-togenic focal epilepsy and the other with Dra-vet sjmdrome, had negative myoclonus and increased seizure frequency associated with continuous spike waves during slow sleep associated with levetiracetam in both cases drug withdrawal led to improvement [208 ]. 

Nervous system In a retrospective analysis of 207 patients treated with levetiracetam, there was a paradoxical increase in seizure frequency or more severe seizures, including generalized tonic-clonic seizures, in 14% of patients [186 ]. Of the 30 patients in the paradoxical effect group, 15 were mentally retarded compared with a much lower percentage of mentally retarded patients in the rest of the group (16/177 = 9%). 

Psychological In a prospective, open, non-interventional study, objective and subjective cognitive measures were evaluated in 401 patients with epilepsy before and 3 and 6 months after introducing levetiracetam [188 ]. Very good tolerance was reported by 68% and cognitive improvement by 58%. Objective improvement was significant in one-quarter of the patients, while 5-6% deteriorated. Adverse events were reported in 28 patients. Psychotropic effects were reported by 1.5%, tiredness by 0.7%, vegetative symptoms by 1.7%, and increased seizure frequency by 0.7% of patients. 

Numerous conventional anti-epileptics were tried (phenyt-oin, midazolam, propofol and levetiracetam) without success. A 50 mg bolus of ketamine followed by 0.6mg/kg/h infusion was then commenced and there was immediate reduction of the frequency and amplitude of the seizures. The dose was increased to a maximum of 3.3mg/kg/h and the seizures stopped, after 12h, sedation was able to be weaned and he was successfully extubated. There was no increase in inotrope requirements during the ketamine infusion. 

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