Seizures levetiracetam

Nervous system Three children with myoclonic seizures were reported to have worsening of their seizures after being started on levetiracetam. All became seizure-free upon withdrawal of levetiracetam and addition of an alternative AED [92 ]. While other antiepileptic medications are known to aggravate generalized seizures, levetiracetam is not typically thought of as one of these medications. 

Lamotrigine Levetiracetam Oxcarbazepine Tiagabine Topiramate Generalized seizures absence (newly diagnosed) ... 

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

Levetiracetam (Keppra) has recently been approved for the treatment of partial-onset seizures. It appears to be safe and effective its exact therapeutic profile has yet to be determined. It does not appear to share any of the mechanisms of action of agents that have been discussed to this point. It does have a highly specific brain binding site, but the significance of this observation to its mechanism of action has not been elucidated. 

Do not discontinue levetiracetam therapy abruptly because this may precipitate seizures strict maintenance of drug therapy is essential for seizure control... 

Levetiracetam As adjunctive therapy in treatment of partial onset seizures in adults with epilepsy. 

Levetiracetam is a piracetam analog that is ineffective against seizures induced by maximum electroshock or pentylenetetrazol but has prominent activity in the kindling model. This is the first major drug with this unusual preclinical profile that is effective against partial seizures. 

Levetiracetam Action on synaptic protein SV2A Well absorbed orally not bound to plasma proteins metabolized to 3 inactive metabolites ty2 6-11 h Generalized tonic-clonic seizures, partial seizures, generalized seizures Toxicity Nervousness, dizziness, depression, seizures Interactions Phenobarbital, phenytoin, carbamazepine, primidone... 

Levetiracetam Keppra Treatment adjunct in partial onset seizures in adults... 

Levetiracetam (Keppra). Levetiracetam has been successful in treating partial seizures in adults when used in conjunction with traditional antiseizure drugs. This drug does not appear to decrease seizure activity via one of the common antiseizure mechanisms (stabilize sodium channels, increase GABA inhibition, and so forth), and the mechanism of this drug is therefore unknown. Levetiracetam is usually well tolerated, although some patients may experience sedation, dizziness, and generalized weakness. 

Partial seizures Carbamazepine Phenytoin Lamotrigine Valproic acid Oxcarbazepine Gabapentin Topiramate Levetiracetam Zonisamide Tiagabine Primidone, phenobarbital Felbamate... 

For simple and complex partial seizures and secondary generalized tonic-clonic seizures, the first line drugs are - carbamazepine, valproate and phenytoin. Second line drugs include - acetazolamide, clobazam, clonazepam, ethosuximide, felbamate, gabapentin, lamotrigine, levetiracetam, oxacarbamazepine, primidone, tiagabine, topiramate and vigabactin. 

Side effects. Detailed safety studies show that levetiracetam is well tolerated, the most frequent side effects reported being somnolence, asthenia and dizziness. To date, levetiracetam would appear to be a highly effective new antiepileptic drug with an excellent safety and tolerability profile. Few drug interactions have been reported so far. The efficacy and safety of the drug have been established as add-on therapy for refractory partial onset seizures with or without secondary generalization and there is now evidence of its efficacy in monotherapy. 

Mula M, Trimble MR, Sander JW. Psychiatric adverse events in patients with epilepsy and learning disabilities taking levetiracetam. Seizure 2004 13(l) 55-7. 

Alsaadi TM, Koopmans S, Apperson M, Farias S. Levetiracetam monotherapy for elderly patients with epilepsy. Seizure 2004 13(1) 58-60. 

Levetiracetam acts in a manner different to other antiepilepsy drugs. It has a potentially broad spectrum of use but is currently indicated for adjunctive treatment in partial seizures with or without secondary generalisation. It is rapidly and completely absorbed after oral administration, and is effective with twice-daily dosing. Its therapeutic index appears to be high and the commonest of the adverse effects are asthenia, dizziness and drowsiness. 

The interpretation of this case is confounded by the use of levetiracetam at the onset of the sjmptoms. In addition, his symptoms appeared just after an admission for videoelectroencephalography, during which he suffered at least one generalized tonic-clonic seizure. Thus, his symptoms could have been a mild form of postictal psychosis. 

Levetiracetam is a piracetam derivative used in the treatment of refractory partial seizures. In trials it has shown an excellent tolerability profile. The main dose-related adverse effects are sedation, fatigue, and headache. Other possible adverse effects include dizziness, unsteadiness, diplopia, nausea, infection, memory impairment, and disturbances of mood and behavior, although in controlled trials the incidence of most of these was no greater than with placebo (1). 

The efficacy and tolerability of levetiracetam 1-2 g/day as add-on therapy have been studied in 324 patients with refractory partial seizures (9). Levetiracetam did not affect the plasma concentrations of other antiepileptic drugs or alter vital signs or laboratory measurements. The most commonly reported adverse effects in patients taking levetiracetam were weakness, headache, and somnolence. 

In a pooled analysis of safety data from double-bUnd, placebo-controUed add-on trials of levetiracetam (1-3 g/ day) in adults with refractory partial seizures, adverse events occurring in at least 3% of patients and with at least 3% higher incidence in the active treatment group were tiredness (14 versus 10%), somnolence (15 versus 10%), dizziness (9 versus 4%), and common cold or upper respiratory tract infections (13 versus 7%) (11). The proportions of patients requiring withdrawal of treatment or dosage reduction owing to adverse events were 15% with levetiracetam and 12% with placebo. The efficacy and tolerability of levetiracetam monotherapy in refractory partial seizures have been studied in a double-blind, pla-cebo-controUed study in 286 patients (12). Adverse events that were more common with levetiracetam and that occurred in more than 5% of cases included weakness, infection, and somnolence. Of 181 patients who took levetiracetam, 36 completed the study compared with only 10 of 105 who took placebo. The tolerability and efficacy of levetiracetam, 2 or 4 g/day, as add-on therapy have been studied in 119 patients with refractory epilepsy (13). Somnolence was the most common reason for withdrawal and occurred more often with levetiracetam than placebo, as did weakness. Somnolence was more common with the higher dose, which was not more effective than... 

The safety of levetiracetam has been assessed in 24 children with uncontrolled partial-onset seizures in an open study (16). The most commonly reported adverse events were headache (33%), infection (33%), anorexia (25%), and somnolence (25%). The adverse events profile of levetiracetam was similar to that seen in adults. Owing to a dispensing error, one patient received an accidental overdose of 71 mg/kg/day, rather than 40 mg/kg/day, during the last 4 weeks of the evaluable phase of the study. No iU effects were reported or observed on examination or laboratory testing, and the patient completed the trial. 

Shorvon SD, Lowenthal A, Janz D, Bielen E, Loiseau P. Multicenter double-bUnd, randomized, placebo-controlled trial of levetiracetam as add-on therapy in patients with refractory partial seizures. European Levetiracetam Study Group. Epilepsia 2000 41(9) 1179-86. 

Shorvon SD, Van Rijckevorsel K, Verdru P. Pooled efficacy and safety data of levetiracetam (LEV) used as adjunctive therapy in patients with partial onset seizures. Epilepsia 1999 40(Suppl 7) 76. 

Betts T, Waegemans T, Crawford P. A multicentre, double-bUnd, randomized, parallel group study to evaluate the tolerabiUty and efficacy of two oral doses of levetiracetam, 2000 mg daily and 4000 mg daily, without titration in patients with refractory epilepsy. Seizure 2000 9(2) 80-7. 

Cereghino JJ, Biton V, Abou-Khalil B, Dreifuss F, Gauer LJ, Leppik I. Levetiracetam for partial seizures results of a double-bUnd, randomized clinical trial. Neurology 2000 55(2) 236-42. 

Glauser TA, Pellock JM, Bebin EM, Fountain NB, Ritter FJ, Jensen CM, Shields WD. Efficacy and safety of levetiracetam in children with partial seizures an open-label trial. Epilepsia 2002 43(5) 518-24. 

Levetiracetam (Keppra) is approved for adjunctive therapy and treatment of partial onset seizures in adults with epilepsy. Levetiracetam is 100% bioavaflable. Once absorbed, it is <10% bound to protein and has a volume of distribution of 1.0 L/kg. Following an oral dose, it reaches maximum... 

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