Meta⁃analysis of adjunctive levetiracetam in refractory partial seizures

Abstract

Objective To evaluate the effects and tolerability of adjunctive levetiracetam (LEV) in refractory partial seizures. Methods Relevant research articles about randomized controlled trials of adjunctive LEV in refractory partial seizures from January 1998 to December 2010 were retrieved from Cochrane Library, MEDLINE, EMbase, Social Sciences Citation Index (SSCI), VIP, Chinese National Knowledge Infrastructure (CNKI) database, China Biology Medicine (CBM). Two reviewers independently evaluated the quality of the included articles and abstracted the data. A Meta⁃analysis was conducted by using RevMan 5.0 software. Results According to the enrollment criteria, eleven prospective, randomized controlled clinical trials with a total of 1192 in LEV group and 789 in placebo group were finally selected. The reduction in three endpoints (a 50% or greater reduction of partial seizure frequency per week, a 75% or greater reduction of partial seizure frequency per week and seizure free) was significant in LEV group than placebo group. There was no significance between LEV group and placebo group in the withdrawl rate (1000 mg/d: OR = 1.180, 95%CI: 0.690-2.010, P = 0.540; 2000 mg/d: OR = 1.530, 95%CI: 0.770-3.030, P = 0.230; 3000 mg/d: OR = 1.000, 95% CI: 0.620-1.600, P = 1.000). The following adverse events were associated with LEV: somnolence (OR = 1.720, 95%CI: 1.280-2.310, P = 0.000), dizziness (OR = 1.490, 95%CI: 1.000-2.220, P = 0.050), asthenia (OR = 1.670, 95%CI: 1.140-2.240, P = 0.008), nasopharyngitis (OR = 1.120, 95% CI: 0.710-1.760, P = 0.630), psychiatric and behavioral abnormalities (OR = 2.120, 95% CI: 1.370-3.280, P = 0.000). Conclusion LEV is effective and well tolerated when added to existing therapy in patients with refractory partial seizures compared with control drugs. Further studies are needed to identify the effects of monotherapy of LEV in partial seizures. DOI：10.3969/j.issn.1672⁃6731.2012.05.009