Initiation Of Levetiracetam Research Articles

A Case of Partial Molar Pregnancy Complicated by HELLP and PRES

Introduction: The term gestational trophoblastic disease encompasses premalignant and malignant conditions arising from trophoblastic cells. Premalignant disorders include complete or partial hydatidiform mole, whereas malignant disorders include invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. Partial hydatidiform moles are triploid in nature and occur when 2 sperm fertilize a single ovum. Preeclampsia is a syndrome complicating 2-8% of pregnancies which presents as new-onset hypertension plus proteinuria. The occurrence of hemolysis, elevated liver enzymes and low platelet count, referred to as HELLP syndrome, is a severe form of preeclampsia. A related severe manifestation is posterior reversible encephalopathy syndrome (PRES) - a clinicoradiological syndrome characterized by symptoms including headache, seizures, altered consciousness and visual disturbances. PRES is commonly associated with acute hypertension. The symptoms of PRES vary widely: i.e., the visual disturbance can vary from blurred vision and homonymous hemianopsia to cortical blindness. Seizures and status epilepticus are common. Although preeclampsia and HELLP syndrome rarely occur before 20-weeks of gestation, reports have suggested early occurrences of these hypertensive disorders specifically in the setting of a molar pregnancy. Case Report: The patient is a 23-year-old, female gravida 1 at 16 week 5 days who presented to an outside emergency department with a 3-day history of progressive abdominal pain which radiated to her back, arms, and shoulders. At the outside facility, the patient had multiple systolic blood pressures greater than 160 mmHg and had a witnessed 30-second seizure which resolved with an intravenous (IV) injection of 2-mg of Lorazepam and 4-gram magnesium sulfate loading dose. She was initiated on magnesium sulfate maintenance pending transfer to our institution. On admission, the patient met criteria for eclampsia and HELLP (platelets 79,000 K/uL, AST 144 U/L, ALT 96 U/L, LDH 482 U/L, Hemoglobin 8.7 g/dL). The beta human chorionic gonadotropin level (HCG) was greater than 200,000 mIU/mL. Bedside ultrasound suggested the presence of an enlarged cystic placenta and a growth restricted fetus (estimated fetal weight 124g, 2%). The patient and her family were counseled and the decision was made to proceed with misoprostol induction and termination of the pregnancy due to maternal indications. During the induction, the patient developed significant vaginal bleeding and was taken to the operating room for an uncomplicated dilation and evacuation. After the procedure, the patient developed progressive visual blurring with 4+ hyperreflexia. Magnetic resonance imaging (MRI) of the brain with and without contrast was obtained with findings significant for PRES. The MRI revealed T2 high-signal lesions within the cortex of the bilateral occipital lobes. Neurology was consulted and recommended blood pressure control and initiation of levetiracetam for seizure prophylaxis. She was initiated on long-acting nifedipine with subsequent blood pressure control. Patient’s visual symptoms and hyperreflexia resolved. Her liver function tests, platelets, and LDH also returned to normal. The patient received contraceptive counseling to prevent pregnancy during gestational neoplastic disease surveillance period. She underwent weekly beta-hCG until negative, followed by three weekly consecutive negative levels before spacing measurements to every 3 months for a period of six months per National Comprehensive Cancer Network (NCCN) guidelines. The pathology results indicated the presence of chorionic villi composed of both large hydropic and smaller normal-appearing villi, a 69.3-gram female fetus compatible with caudal neurocutaneous defect with abnormal localization of brain tissue. The genetic profile of the villous tissue consisted of two sets of dispermic paternal alleles in addition to one set of maternal alleles consistent with a partial mole diagnosis. Discussion: There is an association between preeclampsia and molar pregnancy. Of partial hydatidiform molar pregnancies, 41.9% will develop the symptoms of preeclampsia if left untreated. Although the pathophysiology of eclampsia spectrum disorders is incompletely understood, some evidence points to the role of increased death of trophoblasts and the maternal inflammatory response to trophoblast deportation. Additional evidence points to angiogenic factor imbalance and interestingly, molar placentas produce high levels of antiangiogenic factors. Other causative agents include placental factors that trigger maternal endothelial activation. It is known that trophoblastic debris shed from the placenta into the maternal blood is associated with this condition. It has been demonstrated that trophoblastic debris from molar pregnancies also induces endothelial cell activation through heat-shock protein 70 (HSP70) expressed on a hydatidiform molar placenta, which may be a pathogenic signal to endothelial cells. This case reiterates the association between hydatidiform moles and the hypertensive disorders of pregnancy possibly supporting the theories that such disorders may share an etiologic linkage through trophoblast debris and angiogenic factor imbalance. This case also supports screening molar pregnancies for severe preeclampsia syndrome.

Assessing the Incidence Rate of Neuropsychiatric Adverse Effects in Older Adults Following Levetiracetam Initiation: A Retrospective Study.

Levetiracetam (LEV) is commonly prescribed for epilepsy management. However, neuropsychiatric disorders (NPDs) are concerning adverse effects that may result in medication discontinuation. This study aims to examine the incidence and factors influencing LEV associated NPDs in adult patients aged 50 years and above. A retrospective analysis was conducted on patients aged 50 years and above prescribed LEV between 2010 and 2020, with at least one follow-up appointment six months post-treatment initiation. The incidence of new-onset or aggravated NPDs and variables potentially influencing this risk were examined. Independent t-test, chi-squared, and Fisher's exact test were used, in addition to univariate and multivariate logistic regression. The study included 100 patients with a mean age at LEV start of 63.31 years (SD = 16.48). Neuropsychiatric symptoms were observed in 6 (6.0%) patients. Factors associated with new-onset NPDs were younger age at epilepsy diagnosis (p=0.005), younger age at LEV start (p=0.004), and concurrent use of Carbamazepine/Oxcarbazepine (p=0.004). On multivariate analysis, only the association with Carbamazepine/Oxcarbazepine remained significant (OR 14.62, 95% CI 1.86-114.70, p=0.011). The findings indicate that the incidence of NPDs in elderly patients is relatively low (6%). Further research with larger samples is needed in comparison with a younger sample as a control group to confirm these findings.

Levetiracetam-associated behavioral adverse events in neurocritical care patients.

The objective of this study was to identify the incidence of levetiracetam-associated BAEs in NCC patients. Single-center retrospective cohort analysis. Patient charts. 965 adult ICU patients with a neurological injury receiving levetiracetam that were admitted to an intensive care unit. There were 965 patients included; 52% males with a median GCS of 13. Injury types included TBI (43.1%), ICH (21.8%), SAH (20.5%), and CI (14.6%). BAEs were identified in 46% of patients. Of these, 60% had documentation of agitation/restlessness, delirium, or anxiety while receiving levetiracetam, only 25% had a positive CAM-ICU, 13% had restraints ordered, and 42% received antipsychotics. Patients with TBI had the highest incidence of BAEs (52.4%). The median time to initiation of levetiracetam after hospital admission was 6.4 hours and BAEs occurred after 1.3 days of levetiracetam initiation. In this study, we found that almost half of our NCC population experienced levetiracetam associated BAEs which were mostly hyperactive in nature. We believe that the incidence of BAEs in our specific patient population cannot solely be attributed to ICU delirium given the lower risk of developing hyperactive delirium in ICU patients as compared to other subtypes. Therefore, monitoring and determination of the benefit versus risk in those experiencing BAEs is highly encouraged.

Incidence of Acute Renal Failure in Patients Using Levetiracetam Versus Other Antiseizure Medications: A Voluntary Post-Authorization Safety Study.

Acute kidney injury is an expected adverse drug reaction listed in the European Union (EU) Summary of Product Characteristics (SmPC) for levetiracetam, one of the most widely used modern antiseizure medications (ASMs). We conducted a voluntary post-authorization safety study to characterize the rate of acute renal failure (ARF) in patients exposed to levetiracetam versus other ASMs. New users of ASMs without prior renal dysfunction were identified and followed for 30 days in the IBM® MarketScan® database (USA, January 2008-December 2017). ARF was defined as a diagnosis on inpatient or emergency department claims. We estimated adjusted incidence rates, incidence rate ratios (IRRs), and incidence rate differences (IRDs) of ARF in patients initiating levetiracetam versus other ASMs. Overall, 110,336 patients were eligible for the monotherapy cohort and 96,215 were eligible for the polytherapy cohort. The overall crude rate of ARF following a new ASM was 6.0 and 6.5 per 10,000 patients for the 'monotherapy' and 'polytherapy' cohorts, respectively, in the first 30 days after the index date. In the monotherapy cohort, the IRR for ARF was 1.37 (95% confidence interval [CI] 0.80-2.34) and the corresponding IRD was 2.0 (95% CI -1.12 to 5.12) additional ARFs per 10,000 patient-months. In the polytherapy cohort, the adjusted IRR for ARF was 0.94 (95% CI 0.51-1.74) and the corresponding IRD was -0.42 cases per 10,000 patient-months (95% CI -4.01 to 3.17). The rate of ARFs in ASM new users was very low. In patients without prior ASMs, the estimated difference in risk of ARF associated with initiation of levetiracetam versus initiation of other ASMs was small, with 95% CIs compatible with small protective or harmful effects. In patients receiving polytherapy, the difference was compatible with the null and the 95% CI with small protective or harmful effects.

P-MD021. Drug induced extrapyramidal syndrome in a young girl diagnosed to be SLE

Introduction . Extrapyramidal syndrome is a unique neurological entity. Drugs are an important aetiology capable of causing it at any age group, esp young to adults. SLE is a common autoimmune disease affecting young females and gas a myriad if presentations. Results . This 18 year old girl presented with sudden onset tremulousness of body for 10 days along with difficulty to move her limbs for 6 days. She was on olanzapune and valproate for LADT 3 months because of behavioural abnormalities in the form of abnormal cries/laughters, agitation, aggresive behaviour, convulsions. Her vitals were normal, and systemic examination showed generalised rigidity with tremors. She was evaluated for NMS but her CPK was mildly elevated. She was treated for eps with fluids, stoppage of valproate and olanzapine, initiation of levetiracetam, lorazepam and supportive care. Her workup revealed the diagnosis of SLE with positive anti-ribosomal antibody. She was started on steroids and she is off antipsychotics during her follow-up, doing well. Conclusion . It is equally prudent to find out the cause for need of antipsychotics rather than just its initiation. SLE is an important entity that should be evaluated for psychosis in young females. Immunosuppression is the key for treatment in SLE.

Levetiracetam induced rhabdomyolysis

Abstract: Thirty-three-year-old Caucasian male underwent initiation of levetiracetam following witnessed generalized seizure activity at the same time presenting with a right MCA territory ischemic...

Behavioral alterations associated with levetiracetam in pediatric epilepsy

Levetiracetam (LEV) has an improved pharmacological profile and is one of the most commonly used antiepileptic drugs (AEDs). However, associations between this pharmacological profile and behavioral side effects have been extensively reported in pediatric populations. We assessed behavioral changes after initiation of LEV, prescribed by the treating neurologist, in Chilean patients with epilepsy aged 4–15 years. A behavioral questionnaire was applied at baseline and at two, four, and twelve weeks of treatment. Thirty patients were enrolled: 16 males, 14 females, average age 8 years (range: 4–14). By week four, 23.3% of patients showed significant behavioral alterations that persisted throughout the observation period. No significant alterations emerged after four weeks in the remaining patients. Family history of psychiatric disease and prior behavioral difficulties were predisposing factors for adverse behavioral effects.Although previous studies associated adverse behavioral effects with LEV in pediatric patients with epilepsy, we believe that this is the first study to use a prospective methodology and standardized tools to quantify the symptomatology. Adverse behavioral effects may significantly affect quality of life for patients and families, diminishing the tolerability of treatment. To ensure successful therapy and improve medical decision-making, it is essential to consider predisposing factors for drug-related adverse effects and to regularly assess for behavioral alterations during treatment.

The Application of Density Spectral Array Monitoring in Digital Electroencephalography for Levetiracetam-Induced Non-Convulsive Status Epilepticus in a Patient with Lennox-Gastaut Syndrome

Objective: To analyze the density spectral array (DSA) on the digital electroencephalography (EEG) in a patient with Lennox-Gastaut syndrome (LGS) who developed non-convulsive status epilepticus (NCSE) after initiation of oral levetiracetam (LEV). Methods: Digital EEG was performed on the patient for a 30 min period during the daytime while he was asleep status without hypnotic drugs. The DSA, which incorporated a conventional program of the digital EEG, was sequentially evaluated. Result: The DSA demonstrated that the continuous and periodic high voltages and broad ranges of oscillation, reflecting epileptic activity and the clinical conditions. The EEG demonstrated obvious bilateral frontopolar and/or diffuses 2-3 Hz slow spike-and-wave complex activities, which were not evident before initiation of LEV. Development of LEV-induced NCSE was suspected. Discontinuation of LEV and increasing the dose of clobazam resulted in recovery from NCSE, followed by gradual restoration of the original DSA and EEG findings. Conclusion: On administering of LEV for patients with LGS, the occurrence of NCSE should be carefully monitored. The DSA based on digital EEG was useful for both the diagnosis of NCSE as a drug side-effect and the recovery from its epileptic status.

Low-dose levetiracetam for seizure prophylaxis after traumatic brain injury

Objective: The primary objective of this study was to determine the effectiveness of a lower dose of levetiracetam (500 mg every 12 hours) to prevent early seizures after traumatic brain injury (TBI). It was hypothesized that the seizure rate would be low and comparable to previous studies using phenytoin.Methods: This was a retrospective cohort study conducted in a tertiary care, academic institution that is designated as a level 1 trauma centre in the US. Consecutive patients with TBI were evaluated. Patients who were given a levetiracetam dose of 500 mg every 12 hours were included. The primary outcome was the occurrence of a seizure within 7 days of TBI.Results: There were a total of 169 patients included in the study, who were treated with levetiracetam 500 mg every 12 hours. The median time to first dose of levetiracetam was 3.5 hours after injury (interquartile range = 1–13 hours). After initiation of levetiracetam, there were four (2.4%) patients who had a seizure within 7 days. This was not significantly different than the hypothesized population value of 3.6% (p = 0.390).Conclusions: A lower dose of levetiracetam 500 mg every 12 hours after TBI may be effective for early seizure prevention after TBI.

Levetiracetam

Levetiracetam is a second-generation anticonvulsant that was approved by the Federal Drug Administration in 1999 for the treatment of epilepsy. Recently, levetiracetam has become more popular for the prevention of posttraumatic seizures. Some of the well-known adverse effects of levetiracetam are somnolence, behavioral abnormalities, and less commonly, psychosis. Delirium is not a well-known adverse effect of levetiracetam. Here, we present the case of a 77-year-old Caucasian male who developed disorientation, agitation, and lethargy after initiation of levetiracetam to prevent posttraumatic seizures. Imaging on admission demonstrated a subacute subdural hematoma in the left frontal lobe without mass effect, and the patient was started on levetiracetam 500 mg intravenously twice daily. Less than 24 hours later, the patient began to display a fluctuating level of consciousness, disorientation, an inability to follow commands, and garbled speech. His symptoms continued for 12 days unabated despite episodic treatment with sedatives and antipsychotics. At one point, the patient progressed to aggressive behavior and required restraints. Laboratory tests during this period did not demonstrate signs of infection or metabolic abnormalities. Delirium from levetiracetam was suspected and the drug was discontinued. The patient's mental status improved dramatically within 24 hours after administration of the last dose of levetiracetam and he was discharged home. Based on the Naranjo scale, the episode of delirium was probably related to levetiracetam. Although the other neuropsychiatric effects of levetiracetam are well known, we highlight the first case of delirium without psychotic features associated with levetiracetam.

Hypokalemia and hypomagnesaemia related to levetiracetam use

Levetiracetam (LEV), used for both partial and generalized seizures, is a frequently preferred antiepileptic because of its few side effects. We present a 23-year-old man who developed hypokalemia after switching from valproate to LEV. The patient was sent to our clinic due to hypokalemia 1month after initiation of LEV, and his neurological examination was normal. Further examinations revealed hypokalemia (3.1mmol/L) and hypomagnesaemia (0.56mmol/L). His hemogram, blood urea nitrogen, creatinine, total cortisol, thyroid function tests, creatinine clearance, and renal Doppler ultrasound were normal. LEV was tapered off and treatment with 200mg/day lamotrigine begun. Potassium and magnesium levels returned to normal ranges in subsequent tests. While hypokalemia and hypomagnesaemia have not been reported before to our knowledge, interstitial nephritis and renal failure after the use of LEV have been. Hypokalemia, found in the early period in this case, may be an indicator of a recently developed renal tubular disorder. This experience indicates that unpredictable side effects of increasingly used new antiepileptic drugs should be taken into consideration.

Emergency Department Initiation of Levetiracetam for Seizure: A Cohort Study Examining Psychiatric Risk Assessment and Counseling

Emergency Department Initiation of Levetiracetam for Seizure: A Cohort Study Examining Psychiatric Risk Assessment and Counseling

Continuation rates of levetiracetam in children from the EULEVp cohort study

BackgroundSince indication extension to children data regarding the effectiveness of levetiracetam in paediatric patients remains limited. AimsInvestigate the real-life effectiveness of levetiracetam in paediatric patients. MethodsEpileptic children (<16 years) who had initiated levetiracetam between the 1 October 2006 and the 31 March 2007 were included and followed for 1 year by hospital or non-hospital neurologists practising in France. ResultsAmong the 156 identified children, 147 were analysed: 51.7% were female, and mean (SD) age was 9.2 years (4.2). Most patients had either partial symptomatic (30.6%) or partial cryptogenic (26.5%) epilepsy, 92.5% experienced seizures during the 6 months preceding levetiracetam initiation, and 19.2% were on levetiracetam alone at initiation. One-year levetiracetam continuation rate was estimated to be 72.0% (95%CI [63.8; 78.6]). Of the 104 children continuing levetiracetam treatment at end of study, 31.7% were seizure-free during the last six months of follow-up, and 23.1% on levetiracetam alone. Discontinuation of levetiracetam (n = 41) was mainly for insufficient efficacy (58.5% of those concerned). ConclusionsIn real-life clinical practice important treatment retention and non-negligible reduction of seizure frequency may be expected.

P25 – 2072 Diagnostic clues and difficulties in Dravet syndrome starting from 34 Dravet patients analysis within Romanian Research Group for Rare Genetic Epilepsies

Objectives: Antiepileptic drugs, such as carbamazepine, often increase the serum concentrations of serum lipids. Studies evaluating the effect of levetiracetam (LEV), a newer broad spectrum antiepileptic agent, on serum lipid levels are very limited. The aim of this study was to investigate prospectively the effect of LEV monotherapy on serum lipid profile in children with epilepsy. Material and methods: The study population consisted of 20 children (8 males, 12 females, aged 2 to 15 years old, mean age 6.5±4.16 years) with epilepsy treated with LEV monotherapy. None of the children were receiving any form of AED medication prior to LEV initiation. Serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), apolipoprotein AI (apo A-I), apolipoprotein B (apo B) and lipoprotein (a) [Lp(a)] were evaluated in all children, before and at 2 and 6 months of LEV monotherapy. Results: TC and HDL-C were significantly increased at 6 (p=0.011 and p=0.012, respectively) months of LEV treatment. There were no significant alterations in LDL-C, TGs, apo A-I, apo B and Lp(a) levels during the study. Conclusions: LEV monotherapy may cause significant alterations in TC, and HDL-C levels in children with epilepsy, occurring early in the course of treatment. Long-term, large, prospective studies are required to clarify the possible effect of LEV on serum lipid profile, the underlying mechanisms involved and its clinical significance.

The Honeymoon Effect in Adult Patients with Refractory Partial-Onset Epilepsy Under Levetiracetam Add-on Treatment

Objectives: Resistance to antiepileptic drugs has occurres in some patients. The aim of this study was to evaluate the patients with refractory partial epilepsy who initially responded to levetiracetam (LEV) add-on therapy and who had the seizure frequency return to their baseline after a honeymoon period. Methods: Seven patients with refractory epilepsy, who had transient seizure control with LEV add-on therapy, were included in this study. Age, sex, detailed medical history, epilepsy duration, seizure frequency, concomitant AEDs, time to seizure occurrence after the initiation of LEV, side effects of LEV, cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) data were collected for each patient. Results: Mean age was 26.14±5.14 years. Three patients were male and the other four were female. Mean seizure frequency before LEV treatment was 8.71±5.25 /month. The seizure-free days with levetiracetam add-on therapy was 51-82 days. After the honeymoon effect, seizure frequency returned to the baseline level and did not changed despite an increase in dosage. Cranial MRI was normal in two patients, while interictal EEG was normal in two patients. Conclusion: The resistance to LEV add-on treatment in patients with refractory partial onset seizures may develop, but the honeymoon effect of LEV was longer in our patients when compared to the drug’s literature.

Seizure freedom is not adversely affected by early discontinuation of concomitant anti‐epileptic drugs in the EULEV cohort of levetiracetam users

Fear of discontinuing concomitant anti-epileptic drugs (AEDs) may lead to potentially unnecessary and perhaps unsafe polypharmacy. The effect of withdrawing concomitant AEDs on epilepsy control was therefore studied in long-term users of levetiracetam. The EULEV cohort followed patients initiating levetiracetam in France in 2005 or 2006 for one year. In those maintaining levetiracetam throughout the study period, the association of a reduction in the number of concomitant AEDs during the first six months with seizure-freedom during the last six months of follow-up was investigated using logistic regression. Of the 356 patients continuing levetiracetam for at least 1 year, 140 (39.3%) were seizure-free during the last six months of follow-up. Partial symptomatic or generalised idiopathic epilepsy were associated with greater seizure-freedom than partial cryptogenic disease. Factors associated with seizures were: longer disease duration, initial incapacity, increased number of seizures in the six months preceding levetiracetam initiation, and number of consultations for epilepsy in the six months preceding levetiracetam initiation. There was a trend for the association between the early reduction in the number of concomitant AEDs and seizure-free status later during follow-up, which however did not reach statistical significance in the final propensity score-adjusted multivariate model (OR = 1.8, 95%CI [0.8;4.0]). Taking into account the various risk factors for seizures, the early reduction of concomitant AEDs was not associated with worse seizure rates during follow-up in real-life users of levetiracetam.

Levetiracetam-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome

To describe a case of levetiracetam-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. A 31-year-old white male with a low-grade astrocytoma presenting with tonic-clonic seizures was treated with levetiracetam 1 g twice daily and dexamethasone (initial dosage 12 mg/day, tapered down to 2 mg/day). On day 45 after levetiracetam initiation, dexamethasone was discontinued and levetiracetam continued. The patient developed fever and dyspnea on day 46 and was admitted to the hospital on day 49. A chest X-ray showed bilateral pulmonary interstitial infiltrates, and laboratory tests showed elevated lactate dehydrogenase (LDH; 288 U/L [reference range <204]), ferritin (223 ng/mL [13-178]), and C-reactive protein (CRP; 3.1 mg/dL [<0.5]). Neurologic fever was suspected and the reinitiation of dexamethasone at 6 mg/day was followed by improvement of all symptoms; the patient was discharged on day 55 with dexamethasone 4 mg/day for 2 more days. On day 59, 2 days after the withdrawal of dexamethasone for the second time, the patient presented with a pruritic erythematous maculopapular rash along with recurrence of fever and dyspnea, and was admitted to the hospital. A chest X-ray showed reappearance of the bilateral pulmonary interstitial infiltrates, and laboratory tests showed impaired liver function (alanine aminotransferase 60 U/L [reference range <56], aspartate aminotransferase 53 U/L [<30], LDH 516 U/L, ferritin 419 ng/mL, and CRP 2.6). A diagnosis of DRESS syndrome was suspected and levetiracetam was discontinued. Upon levetiracetam withdrawal, the patient's symptoms resolved by day 66, and radiological images showed resolution of the interstitial infiltrate by day 68. The patient was discharged on day 68. Low-grade fever persisted until day 71, with no other symptoms. During a 2-month follow-up period, liver function test results returned to normal. DRESS is a hypersensitivity reaction to several drugs, mainly antiepileptic drugs (AEDs), characterized by cutaneous, hematologic, and visceral involvement. Levetiracetam is structurally and pharmacologically unrelated to other AEDs. Previously, only one case of levetiracetam-induced DRESS syndrome had been reported, which required corticosteroids to control symptoms. We describe a case of levetiracetam-induced DRESS syndrome presenting with pneumonitis and hepatitis that resolved with levetiracetam withdrawal. Our patient was classified as a definitive DRESS case according to the RegiSCAR scoring system, which grades DRESS cases. According to the Naranjo probability scale, the adverse drug reaction was considered probable. Although levetiracetam is usually well tolerated, clinicians should be aware of the potential for it to cause DRESS syndrome.

Treatment with levetiracetam in a patient with pervasive developmental disorders, severe intellectual disability, self-injurious behavior, and seizures: A case report

Pervasive developmental disorder is characterized by various symptoms that often include self-injurious behavior (SIB). Episodes of SIB occur in the context of high emotional arousal, anger, or fear and may be related to epilepsy. We report the case of a 20-year-old man with pervasive developmental disorder presenting with SIB non-responsive to antipsychotic medication. Positron emission tomography showed a right temporoparietal hypometabolic focal lesion suggestive of an epileptic focus. Two weeks after initiation of levetiracetam (Keppra®), SIB disappeared, without recurrence 24 months later. Levetiracetam (Keppra®) may be beneficial for such patients.

A prospective study of levetiracetam efficacy in epileptic syndromes with continuous spikes-waves during slow sleep

Purpose To evaluate the add-on effect of levetiracetam (LEV) treatment on the EEG and clinical status of children with continuous spikes-waves during slow sleep (CSWS). Methods 20 children with CSWS refractory to other conventional antiepileptic drugs (AEDs) received LEV 45–50 mg/kg/day as add-on treatment, and were prospectively followed for a minimum period of 18 months. The patient population comprised seven cryptogenic, seven symptomatic and six idiopathic cases (atypical benign partial epilepsy, aBECTs). The electrographic evaluation included 24 h EEG recordings taken every six months (minimum of three per child). Electrographically children were categorised as responders, partial responders or non-responders by comparing changes in the spike index (SI) during NREM-sleep with baseline SI before initiation of LEV. The clinical efficacy of LEV was assessed by comparing seizure frequency at the end of follow up with the baseline. The follow up duration varied from 18 to 53 months. Results Electrographic response was observed in 11 patients. Eight patients demonstrated a lasing response (more than 12 months): five from symptomatic, two – cryptogenic and one – idiopathic group respectively. Three children showed a partial response (6–12 months): one from symptomatic and two from idiopathic group. Eleven out of the 20 children were seizure free at baseline and during the whole follow up. The rest, six-symptomatic and three-cryptogenic patients, had seizures prior to LEV treatment initiation. Six became seizure free after add-on therapy with LEV, and in three children a significant reduction of seizure frequency was observed. Conclusion This study suggests that add-on therapy with LEV is more effective in children with CSWS resulting from a known underlying structural brain lesion (the symptomatic group).

The EULEV cohort study: rates of and factors associated with continuation of levetiracetam after 1 year

Levetiracetam has shown good safety/tolerability and efficacy in regulatory trials. This was confirmed in observational investigations performed soon after marketing by using continuation or retention rates as a composite measure. When an anti-epileptic drug first becomes available; however, there is evidence of channelling to more severe patients than thereafter. This study was performed several years after marketing of levetiracetam and found high rates of continuation. It also further explores this measure by determining the continuation in the absence of initiation of additional anti-epileptic drugs. To investigate real-life effectiveness of levetiracetam in patients initiating treatment in a stable market situation. Epileptic adults who had initiated levetiracetam between 1 January and 31 August in 2005 or 2006 were included and followed for 1 year by hospital or nonhospital neurologists practising in France. One-year continuation rates were estimated using Kaplan-Meier analysis. Among those still treated at end of study, treatment goals were investigated. Factors associated with discontinuation were investigated using Cox proportional hazards regression. A total of 794 subjects were included in the cohort, and 753 subjects were followed up and included in the analysis. Among these, mean (SD) age was 42.6 (±17.0) years, 51.1% were female, 76.6% had partial epilepsy, 93.5% had seizures in the 6 months preceding levetiracetam initiation and 82.9% had at least one concomitant anti-epileptic drug when starting levetiracetam. One-year levetiracetam continuation rate was 83.5% (95% confidence interval, 80.5-86.0%). Of the 579 patients still using levetiracetam at end of study, 46.8% were seizure free during the last 6 months, and 24% were on levetiracetam monotherapy. Reasons for discontinuation (n= 122) were adverse events (45%), lack of efficacy (38%) or both (9%). Levetiracetam discontinuation was most strongly associated with previous exposure to more than four anti-epileptic drugs, whereas continuation was most strongly associated with presence of seizure-related falls in the 6 months preceding levetiracetam initiation. This population-based cohort study in a stable market situation found a high 1 year levetiracetam continuation rate compared with previous studies done sooner after market introduction.