Role of intravenous levetiracetam in status migrainosus

Abstract

Migraine pathophysiology remainselusive. A relationship betweenmigraine and epilepsy has been pro-posed [1] and antiepileptic drugs(AEDs) are being used extensivelyfor migraine prophylaxis and treat-ment. Newer AEDs with novel mech-anisms of action may also help to pre -vent and treat migraines. The avail-ability of an IVform of an AEDallows rapid administration and there -fore could be used in the managementof status migrainosus (SM). Leveti-racetam (LEV) is one of the newerAEDs and has multiple mechanismsof action including favourable inter-actions with gamma amino butyricacid (GABA) and glycine receptors,antagonism of the activity of negativemodulators of GABA, modulation ofN-type calcium and glycine-gatedcurrents, and the selective binding tothe synaptic vesicle protein 2A [2, 3].The role of LEVin prophylaxis ofrefractory migraines and otherheadache syndromes has been report-ed [4–7]. The IVform of levetirac-etam (IV-LEV) has recently becomeavailable. With all the advantages ofthe newer-generation AEDs, includ-ing the minimal side effects and druginteractions, IV-LEV might also be apotential candidate for the treatmentof migraine and SM.We report the case of a 27-year-old woman with a history of migrainewith aura and complex partial (CP)epilepsy with occasional secondarygeneralisation. She had been seizure-free on oral LEV 750 mg twice dailyfor 2 years. She came to the emer-gency department (ED) with worsen-ing of her usual migraine headachesfor more than 72 h. In the ED, shesuffered a 2-min episode of CPseizure with secondary generalisationand was given an infusion of 1000 mgIV-LEV over 15 min. She returned toher clinical baseline and her headacheresolved 35 min after the infusion.She tolerated the infusion well andwithout side effects. She wasobserved for 24 h and maintained onher usual oral LEV without anybreakthrough seizures or headaches.