Status epilepticus levetiracetam

The short-term effects of intravenous levetiracetam as the treatment of choice for status epilepticus have been evaluated in nine elderly patients (five women median age 78 years) [197 ]. In all but one, intravenous levetiracetam was effective and there were no adverse reactions or changes in electrocardiography or laboratory parameters. 

Fattouch J, Di Bonaventura C, Casciato S, Bonini F, Petrucci S, Lapenta L, Manfredi M, Prencipe M, Giallonardo AT. Intravenous levetiracetam as first-line treatment of status epilepticus in the elderly. Acta Neurol Scand 2010 121(6) 418-21. 

A 4-year-old previously healthy girl presented with new-onset seizures associated with fevers, headache, and malaise. She developed status epilepticus resistant to intravenous tenzodiaz-epines, fosphenytoin, levetiracetam, valproate, pentobarbital, and ketamine. An initial MRI brain scan was unremarkable. Isoflurane was begun, and an MRI scan 14 days later showed hyperintense T2 signals in the cerebellar vermis and cerebellar hemispheres. The isoflurane concentration was reduced to 0.5% and a further scan after 31 days of isoflurane therapy showed improvement in the signal abnormalities. Her isoflurane exposure was 1382% concentration-hours/1257 MAC-hours. She remained minimally conscious. 

A 76-year-old woman with seizures secondary to ischemic stroke developed status epilepticus despite treatment with clonazepam. She was given intravenous levetiracetam 1000 mg/day and 2 days later developed pancytopenia, with a hemoglobin concentration of 9.8 g/dl, a platelet count of 83 x 10 A, and a white blood cell count of 5.7 x 10 /1. These changes worsened during the next 4 days and she required blood transfusion. Levetiracetam was withdrawn and 2 days later the blood cell count improved. When rechallenge with oral levetiracetam 0.5 g/day 1 year later pancytopenia rapidly recurred. 

A woman developed status epilepticus during the first trimester of pregnancy, which might have been caused by a fall in her levetiracetam blood concentrations [202 ]. The clearance of levetiracetam increases during pregnancy, particularly during the third trimester, probably due to increased renal blood flow. 

In 12 adults with status epilepticus, intravenous levetiracetam 2500 mg was added as soon as possible to a standardized regimen of intravenous clonazepam and/or rectal diazepam as needed followed by phenytoin or valproic acid no serious adverse effects could be related directly to the administration of levetiracetam [208 ]. 

In a retrospective analysis of 36 patients who received intravenous levetiracetam for refractory status epilepticus [209 ] a median dose of 3000 mg/day (range 1000-9000) was used as a loading bolus or by continuous pump infusion. Status epilepticus was terminated in 69% of patients. None had cardiac dysrhythmias or significantly reduced blood pressure, or required an increase in the dose of catecholamines. Two patients had nausea and vomiting during levetiracetam loading, leading to aspiration pneumonia in one. 

In a retrospective study of 32 patients who had been given intravenous levetiracetam for status epilepticus, there was arterial hypotension after intravenous levetiracetam in four patients during co administration of propofol and during rapid infusion of phenytoin in one patient [210 ]. There... 

In a retrospective study in 43 patients with various forms of status epilepticus after ineffective treatment with benzodiazepines, intravenous levetiracetam was given as a short infusion of 1000 or 2000 mg [211 ]. Status epilepticus was terminated in 19. There were no severe adverse reactions. Among patients aged over 80, somnolence was reported, which could have been due to benzodiazepines, and/or post-seizure twilight state. There were no metabolic disturbances or interactions. 

In a retrospective chart study of 34 patients with status epilepticus who were given intravenous levetiracetam, the median loading dose of levetiracetam was 1000 mg and the maintenance dosage was 500-1500 mg/12 hours (median 1000 mg/12 hours) [212 ]. Status epilepticus stopped in a clear temporal relation to drug infusion in 71% of patients and there were no serious adverse events. 

Novy J, Hubschmid M, Michel P, Rossetti AO. Impending status epilepticus and anxiety in a pregnant woman treated with levetiracetam. Epilepsy Behav 2008 13(3) 564-b. 

Uges JW, van Huizen MD, Engelsman J, Wilms EB, Touw DJ, Peelers E, Vecht CJ. Safety and pharmacokinetics of intravenous levetiracetam infusion as add-on in status epilepticus. Epilepsia 2009 50(3) 415-21. 

Mbddel G, Bunten S, Dobis C, Kovac S, Dogan M, Fischera M, Dziewas R, Schabitz WR, Evers S, Happe S. Intravenous levetiracetam a new treatment alternative for refractory status epilepticus. J Neurol Neurosurg Psychiatry 2009 80(6) 689-92. 

Berning S, Boesebeck F, van Baalen A, Kellinghaus C. Intravenous levetiracetam as treatment for status epilepticus. J Neurol 2009 256(10) 1634-A2. 

Eue S, Grumbt M, MAWller M, Schulze A. Two years of experience in the treatment of status epilepticus with intravenous levetiracetam. Epilepsy Behav 2009 15(4) 467-9. 

Gamez-Leyva G, Aristan JL, Fernandez E, Pascual J. Experience with intravenous levetiracetam in status epilepticus a retrospective case series. CNS Drugs 2009 23(11) 983-7. 

Observational studies A phase 111 study evaluated the safety and efficacy of levetiracetam in 217 children and adults with primary generalized seizures. The most common adverse effects reported by >10% participants were headache and nasopharyngitis. The most frequent treatment-associated adverse effects were headache (4.6%), dizziness and depression (both 4.1%). Serious adverse effects related to treatment with levetiracetam 4.6% of patients experienced convulsion, atrial fibrillation, epilepsy, depression, psychosis, schizophrenia, suicidal ideation, erythematous rash, and status epilepticus. One patient each discontinued due to the following adverse effects arrhythmia, convulsions, tremor, aggression, depression, psychosis, and exanthem. One patient with worsening of comorbid schizophrenia committed suicide it had been 43 days since he had last taken levetiracetam at the time [87 -]. 

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