Abstract
Background and Aim. Levetiracetam is a second-generation antiepileptic drug. It is approved as an adjunctive treatment of partial onset seizures with or without secondary generalization. It is considered safe with less than 1% of patients with transient elevations of liver enzymes. Methods. We report a case of acute liver failure secondary to Levetiracetam in combination with Lacosamide documented with a liver biopsy. Results. Liver biopsy demonstrated acute liver injury with a predominant submassive necrosis pattern and features of a drug-induced hepatitis. Conclusions. This is the first published case of acute liver failure due to antiepileptic therapy with Levetiracetam in combination with Lacosamide.
Highlights
Levetiracetam is an established second-generation antiepileptic drug that is approved as a treatment of partial seizures; other indications include adjunctive treatment of myoclonic seizures associated with juvenile myoclonic epilepsy and primary generalized tonic-clonic seizures associated with generalized epilepsy
General laboratory test was assessed; in these, liver transaminases and serum bilirubin were normal. She takes Alprazolam 2 mg a day in case of insomnia and no other drugs. The day before her admission she complained of dizziness; she had syncope and presented with status epilepticus, with ten continuous episodes of generalized tonic-clonic convulsions of seconds to five minutes of duration, followed by disorientation and sleepiness; for this reason she doubled the Levetiracetam dose; in spite of this, she continued with convulsive crisis; subsequently she presented to the emergency room of our hospital
That Levetiracetam and Lacosamide combination that appears responsible for the observed liver injury seems quite convincing based on the temporal relationship between administration of the drug and the onset of clinical symptoms, the marked transaminases level elevation in combination with the histologic findings, the absence of alternative diagnosis, and the significant improvement with discontinuation of the drug
Summary
Levetiracetam is an established second-generation antiepileptic drug that is approved as a treatment of partial seizures; other indications include adjunctive treatment of myoclonic seizures associated with juvenile myoclonic epilepsy and primary generalized tonic-clonic seizures associated with generalized epilepsy. Lacosamide, previously known as Erlosamide, is an adjunctive treatment for epilepsy as well as monotherapy for diabetic neuropathic pain. It appears to have a dual mode of action: selective enhancement of sodium channel inactivation and modulation of collapsin response mediator protein 2. Recent data supports this, suggesting that Lacosamide is a safe treatment in critically ill patients, and there is only one report of elevation of liver function tests in a recent retrospective study [4]. We report a case of acute liver failure with secondary multiorganic failure associated with Levetiracetam and Lacosamide treatment in a patient with unknown etiology seizures
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