Role of intravenous levetiracetam in acute seizure management.

Abstract

Epilepsy is a chronic medical condition that still poses a challenge in terms of treatment. There are a variety of anticonvulsants available today, but these do not prevent frequent hospital admissions and emergency room visits. Benzodiazepines, however, remain the first line treatment in acute seizure management. The approval of phenytoin, fosphenytoin, intravenous valproate, and rectal diazepam has given more options to the physicians for acute management. The approval of intravenous levetiracetam has provided another option for physicians with patients who failed the other approved anticonvulsants. Intravenous levetiracetam is approved for patients 4 years and older as an alternative to oral treatment. There have been various case reports, case series, and retrospective studies showing the efficacy of intravenous levetiracetam both in status epilepticus (SE) and acute seizure exacerbation. These studies reported favorable response of intravenous levetiracetam in both adults and children. Data have even shown good results in neonates and preterm children. In this volume, we have included articles from renowned researchers in the field of neurology and epilepsy who have covered the various aspects of these agents in detail including the properties, mechanism of action, pharmacology, neurobehavioral effects, and the roles of these agents in special populations. These data further show that intravenous levetiracetam can be used in acute seizure management. This book opens with a chapter by Jennifer L. DeWolfe and Jerzy P. Szaflarski (1) that discusses in detail the role of intravenous levetiracetam in the critical care setting. The literature review was conducted, which showed that intravenous levetiracetam is effective in terminating different types of seizures including SE, post-traumatic and tumor-related seizures, seizures due to stroke, and intraparenchymal hemorrhage. The pharmacokinetics of this agent in special populations including elderly, pregnant, and neurocritical patients is also discussed in this chapter. The authors concluded that there is still need for larger prospective trials, but based on current data, the drug appears to be safe and better tolerated in different subgroups of seizure population. The second chapter by Wright et al. (2) reviewed the current literature about the pharmacology and pharmacokinetics of intravenous levetiracetam and the safety profile of this drug in adults and children. The article also showed unique mechanism of action, linear pharmacokinetics, and no known drug‐drug interactions with other anticonvulsants, which makes it a viable option for acute seizure management in both adults and children. The third chapter by Aceves et al. (3) further discusses in detail the current data regarding the safety and tolerability of intravenous levetiracetam in children and neonates in the management of SE and acute repetitive seizures. The authors also emphasize the need for a larger prospective multicenter trial to further define the roles of these