Levetiracetam In Children Research Articles

Safety And Efficacy of Lacosamide and Levetiracetam in Children –A Cohort Study

Safety And Efficacy of Lacosamide and Levetiracetam in Children –A Cohort Study

Psychiatric and behavioral concerns of perampanel with concomitant levetiracetam in children with epilepsy

PurposePerampanel (PER) is expanding the therapeutic scope for pediatric epilepsy owing to its efficacy and favorable safety profile. However, concerns about psychiatric and behavioral adverse events (PBAEs) in combination therapy with levetiracetam (LEV) continue to contribute to hesitation in its prescription. We investigated the risk profiles for PBAEs when adding PER to pediatric epilepsy treatment and analyzed the differences according to the presence of concomitant LEV. MethodsWe retrospectively reviewed the medical records of children aged 4–18 years with epilepsy who were prescribed PER as adjunctive therapy from March 2016 to February 2023. We compared the occurrence and management of PBAEs between the PER without LEV and PER with LEV groups. The risk factors for PBAEs were also analyzed. ResultsNinety-four patients (53 boys and 41 girls) were included in this study. The median age of total patients at the time of adding PER was 14.9 years (12.3–16.4 years), and 53 patients (56.4 %) had concomitant LEV. Forty-seven PBAEs occurred in 34 patients (36.2 %), with no significant differences depending on whether concomitant LEV is present or not. The most common PBAEs were aggression (14.9 %), irritability (9.6 %), affect lability (7.4 %), and acute psychosis (6.4 %). PBAEs occurred at a lower dosage (2–6 mg/day) in 70.6 % of the patients. In addition, 73.5 % of patients with PBAEs continued PER treatment by follow-up observation or by reducing the PER dosage. No risk factors, such as the presence of concomitant LEV or lamotrigine, any comorbid conditions, higher PER dosage (8–12 mg/day), two or more concomitant anti-seizure medications, and younger age (<13 years) at PER add-on, showed significant associations. ConclusionWhen expanding the use of anti-seizure medications in pediatric patients, real-world evidence on safety issues is crucial for pediatric epileptologists. We confirmed that combination therapy with PER and LEV did not increase the risk profile of PBAEs.

Pharmacokinetics and Proposed Dosing of Levetiracetam in Children With Obesity.

Characterize levetiracetam pharmacokinetics (PK) in children with obesity to inform dosing. Children 2 to <21 years old receiving standard of care oral levetiracetam across two opportunistic studies provided blood samples. Levetiracetam plasma PK data were analyzed with a nonlinear mixed-effects modeling approach. Indirect measures for body size and covariates were tested for model inclusion. Individual empirical Bayesian estimates using the final model parameters were compared by obesity status. Monte Carlo simulation using total body weight was performed in children with normal estimated glomerular filtration rate to identify dosing for children with obesity that resulted in comparable exposures to normal weight adults and children after receiving label dosing. The population PK model was developed from 341 plasma concentrations from 169 children. A 1-compartment model best fit the data with fat-free mass as a significant covariate. Compared with children with normal weight, children with obesity had significantly lower body weight-normalized clearance (median [range], 4.77 [1.49-10.44] and 3.71 [0.86-13.55] L/h/70 kg, respectively). After label dosing with the oral formulation in children with obesity 4 to <16 years old, maximum and minimum steady-state concentrations were higher (25% and 41%, respectively [oral solution] and 27% and 19%, respectively [tablet]) compared with children with normal weight. Comparable exposures between children with and without obesity were achieved with weight-tiered dosing regimens of <75 kg or ≥75 kg. Weight-tiered dosing for levetiracetam oral solution and tablets for children with obesity 4 to <16 years old results in more comparable exposures to children of normal weight.

The Drug-Induced Hypoglycemia in Children: Is Levetiracetam Incriminated?

Levetiracetam is a well-tolerated anticonvulsant drug, but associated with some adverse effects. To date, there is no report of hypoglycemia associated with levetiracetam. We report the case of a 6-year-old female patient who developed symptomatic hypoglycemia after initiation of treatment with levetiracetam for her refractory status epilepticus and we review the literature to identify other reports of hypoglycemia. Associated with levetiracetam in children in order to highlight this rare adverse effect and a possible dose effect. Hypoglycemia is a rare and underestimated adverse effect of Levetiracetam and which must be taken into account and treated appropriately, in particular when high doses are given; allowing a saving of a multiple of unnecessary additional examinations.

Investigation of cross-reactivity between phenobarbital and levetiracetam in children with epilepsy: A prospective, observational multicenter study.

Pharmaceutical allergic reactions due to antiseizure medications (ASMs) are one of the major concerns in the management of patients. Finding an alternative ASM which does not cause allergic reactions and has acceptable effectiveness can be difficult. In this regard, the present study attempts to investigate the cross-reactivity between phenobarbital and levetiracetam in children under treatment for seizure control. The present study is a prospective, observational independent assessor study. 30 children with epilepsy who were hypersensitive to phenobarbital therapy were studied. In order to evaluate the cross-reactivity of the drugs, levetiracetam replaced phenobarbital to control seizure. Within 6months, any allergic reactions and seizure recurrences were evaluated in the patients. 53% of the children in this study were female. The mean age of patients was 42.4months. In patients' follow up no cross-reactive responses were observed in any of the patients. Seizure recurrence rate was 30% in the first six months of follow up that with increasing dosage in the second six months of follow-up, decreased to 10%. Based on the results of this study, in children with epilepsy controlled by phenobarbital if allergic reactions to phenobarbital occur, levetiracetam may be used as a suitable alternative medicine.

Efficacy and safety of switching from brand-name to domestic generic levetiracetam in children with epilepsy.

To study the efficacy and safety of domestic generic levetiracetam in replacement of brand-name levetiracetam in the treatment of children with epilepsy. A retrospective analysis was performed on the medical data of 154 children with epilepsy who received domestic generic levetiracetam in the inpatient or outpatient service of Guangdong Provincial People's Hospital from May 2019 to December 2020. Domestic generic levetiracetam and brand-name levetiracetam were compared in terms of efficacy and safety. For these 154 children, the epilepsy control rate was 77.3% (119/154) at baseline. At 6 months after switching to domestic generic levetiracetam, the epilepsy control rate reached 83.8% (129/154), which showed a significant increase (P<0.05). There was no significant change in the frequency of seizures from baseline to 6 months after switching (P>0.05). The incidence of refractory epilepsy in children with no response after switching treatment was significantly higher than that in children with response (P<0.05). Before switching, only 1 child (0.6%) experienced somnolence, while after switching, 3 children (1.9%) experienced mild adverse drug reactions, including dizziness, somnolence, irritability, and bad temper. Switching from brand-name to generic levetiracetam is safe and effective and holds promise for clinical application, but more prospective randomized controlled trials are required in future.

Comparative Efficacy of Levetiracetam for Epilepsy in School-Aged Children with Intellectual Disability and Normal Intelligence.

Choosing optimal anti-seizure medication (ASM) is very important in pediatric patients with epilepsy who attend school, especially children with an intellectual disability (ID). Levetiracetam (LEV) has proven to be an effective, safe, generally well-tolerated, broad-spectrum ASM in children. In the context of increasing use of LEV in school-aged children with epilepsy and ID, we evaluate relevant clinical data, including efficacy, safety, and tolerability in children with epilepsy and an intellectual disability (ID) or normal intelligence (NI). We performed a retrospective chart review of children and included 298 pediatric patients with epilepsy who were treated with LEV with NI (147) and ID (151). After 6 months, 96% of NI and 83% of ID subjects had a seizure reduction rate greater than 50% (p = 0.031). The tolerability of LEV was generally good, with 75% retention rates at 2 years in both groups and only minor side effects (under 15%). The retention rates of patients with NI and ID were 76% and 74%, respectively (p = 0.597). Thus, LEV showed considerable efficacy with minimal side effects and high retention rates and is an easily maintained and safe treatment option for pediatric epilepsy with ID. However, better-designed research studies are needed to clearly elucidate the efficacy and safety of LEV in children with epilepsy and ID.

Predictive Performance of Population Pharmacokinetic Models of Levetiracetam in Children and Evaluation of Dosing Regimen

Levetiracetam is a broad-spectrum antiepileptic drug that exhibits high interindividual variability in serum concentrations in children. A population pharmacokinetic approach can be used to explain this variability and optimize dosing schemes. The objectives are to identify the best predictive population pharmacokinetic model for children and to evaluate recommended doses using simulations and Bayesian forecasting. A validation cohort included children treated with levetiracetam who had a serum drug concentration assayed during therapeutic drug monitoring. We assessed the predictive performance of all the population pharmacokinetic models published in the literature using mean prediction errors, root mean squared errors, and visual predictive checks. A population model was finally constructed on the data, and dose simulations were performed to evaluate doses. We included 267 levetiracetam concentrations ranging from 2 to 69 mg/L from 194 children in the validation cohort. Six published models were externally evaluated. Most of the models underestimated the variability of our population. A 1-compartment model with first-order absorption and elimination with allometric scaling was finally fitted on our data. In our cohort, 57% of patients had a trough concentration <12 mg/L and 12% <5 mg/L. To reach a trough concentration >5 mg/L, doses ≥30 mg/kg/d for patients ≤50 kg and ≥2000 mg/d for patients >50 kg are required. In our population, a high percentage of children had low trough concentrations. Our population pharmacokinetic model could be used for therapeutic drug monitoring of levetiracetam in children.

Efficacy and safety of levetiracetam as adjunctive therapy for refractory focal epilepsy.

Epilepsy affects about 50 million people worldwide and around 30% of these patients have refractory epilepsy, with potential consequences regarding quality of life, morbidity and premature mortality. The aim of treatment with antiseizure medications (ASMs) is to allow patients to remain without seizures, with good tolerability. Levetiracetam is a broad-spectrum ASM with a unique mechanism of action that differs it from other ASMs. It has been shown to be effective and safe for treating adults and children with epilepsy. This was a phase III, multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of levetiracetam in children and adults (4-65 years) as an adjuvant treatment for focal-onset seizures. It was conducted among 114 patients undergoing treatment with up to three ASMs. The primary efficacy analysis was based on the proportion of patients who achieved a reduction of ≥ 50% in the mean number of focal seizures per week, over a 16-week treatment period. The patients were randomized to receive placebo or levetiracetam, titrated every two weeks from 20 mg/kg/day or 1,000 mg/day up to 60 mg/kg/day or 3,000 mg/day. Levetiracetam was significantly superior to placebo (p = 0.0031); 38.7% of the participants in the levetiracetam group and 14.3% in the control group shows reductions in focal seizures. Levetiracetam was seen to have a favorable safety profile and an adverse event rate similar to that of placebo. Corroborating the results in the literature, levetiracetam was shown to be effective and safe for children and adults with refractory focal-onset epilepsy.

Amelioration of Levetiracetam-Induced Behavioral Side Effects by Pyridoxine. A Randomized Double Blind Controlled Study

BackgroundLevetiracetam is a relatively new-generation antiseizure drug approved for the treatment of focal and generalized seizures. Despite its favorable side effect profile and minimal drug-drug interactions, neuropsychiatric side effects are reported in up to 13% of children. A few case series have suggested that supplementation of pyridoxine may mitigate these side effects, but controlled trials are lacking. To address this issue, a randomized interventional study was carried out in a pediatric tertiary hospital to qualify and quantify the potential beneficial effect of pyridoxine in attenuating the neuropsychiatric side effects of levetiracetam in children. MethodsA total of 105 children with epilepsy who were taking levetiracetam (as a monotherapy or an adjunct) who showed behavioral symptoms coinciding with the start of levetiracetam, were included. Patients randomly and blindly received either a therapeutic (pyridoxine group, 46 of 105, 44%) or a homeopathic dose of pyridoxine (placebo, 59 of 105, 56%). A 30-item behavioral checklist was used to qualify and quantify the behavioral side effects at baseline and at different time points following initiation of treatment. ResultsBoth placebo and pyridoxine groups experienced a statistical reduction in behavioral scores when compared with baseline. Our study indicated that although there was a placebo effect, the improvement in neuropsychiatric symptoms was more prominent in children who received therapeutic doses of pyridoxine. ConclusionsThese data provide clinicians with pertinent evidence-based information that suggests that a trial of pyridoxine in patients who experience behavioral side effects due to the use of levetiracetam may avoid unnecessary change of antiseizure medications.

Efficacy and safety of levetiracetam in children with epilepsy: protocol for an umbrella review of systematic reviews and meta-analyses of randomised controlled trials

IntroductionEpilepsy causes serious suffering in children and is associated with high morbidity and increased mortality. It impairs children’s quality of life and places a heavy burden on healthcare resources. Levetiracetam...

Pyridoxine Add-On Treatment for the Control of Behavioral Adverse Effects Induced by Levetiracetam in Children: A Case-Control Prospective Study.

Few studies on adult and pediatric patients have shown pyridoxine efficacy as additional therapy for those receiving levetiracetam (LEV) to prevent and mitigate behavioral adverse effects (BAEs). The aim of our study was to analyze the safety and efficacy of pyridoxine supplementation in the prevention of LEV adverse effects, including suicidal ideation. This randomized, case-control trial included patients receiving LEV as monotherapy treatment. Patients were subdivided into 2 groups, according to whether they were treated with LEV only (group 1) or LEV with supplemental pyridoxine (group 2). In both cohorts, the most frequent BAEs were irritability/aggression followed by depression and confusion. Those patients (92%) who initiated pyridoxine after 1 month of LEV treatment did not need to change or suspend LEV ( P < 0.001), and BAE improved after 9.06 ± 3.05 days of pyridoxine supplementation. None of the patients complained of symptoms of pyridoxine toxicity, and no new adverse effects of LEV off-label were reported. In our study, we found pyridoxine to be safe and effective in controlling LEV-induced BAEs in children.

EFFICACY AND SAFETY OF LEVETIRACETAM IN CHILDREN WITH ELECTRICAL STATUS EPILEPTICUS DURING SLOW-WAVE SLEEP (ESES)

Electrical status epilepticus during slow-wave sleep (ESES) is an EEG pattern of continuous (85-100%) diffuse epileptiform activity in the sleep EEG. The morphology of the epileptiform complexes is identical to benign epileptiform discharges of childhood (BEDC). Epilepsy with ESES (or “Penelope Syndrome”) is a form of age-dependent epileptic encephalopathies with the phenomenon of continuous spike-waves during slow wave sleep. This group of epilepsies also includes Pseudo-Lennox syndrome, Landau-Kleffner syndrome, autistic epileptiform regression and some others. In most cases, the ESES pattern correlates with the severity of cognitive deficit in this population of epileptic children. The aim of this study was to evaluate the efficacy and safety of levetiracetam in children with the ESES pattern in the EEG. Materials and Methods. During the period of 2010-2016, 34 epileptic children with ESES patterns in the EEG (14 boys and 20 girls) treated with levetiracetam (33 in combined and 1 in monotherapy) were studied. Results. Twenty eight of the patients with ESES patterns in the sleep EEG were diagnosed with the ESES form of epilepsy. Among them, 7 idiopathic, 13 symptomatic, and 8 “symptomatic” cases of ESES (the latter resulted from “double pathology” of idiopathic + hypoxic-ischemic factors and these children had cerebral palsy). Among other ESES patients, 3 cases were of Pseudo-Lennox syndrome, 2 cases of Landau-Kleffner syndrome and one girl with autistic epileptiform regression. All 28 children received levetiracetam at therapeutic doses of 20-80 mg/kg/daily. Levetiracetam was highly effective in 67.6% of patients (n=23); of those, 2 children showed full clinical and electroencephalographic remission before reaching puberty, 9 children had clinical remission and 12 children had a significant decrease in seizures and epileptiform discharges. A low efficacy of levetiracetam was seen in 20.6% (n=7) of patients. Disease aggravation (seizures and epileptiform discharges) was found in 11.8% (n=4) of patients. Other negative effects were observed in only 4 (11.8%) children (3 cases of agitation and sleep disturbance and one case of allergic rash). In conclusion, levetiracetam is a highly effective medication (67.6% of cases) in combined antiepileptic therapy in children with ESES. However, the risk of exacerbation was as high as 11.8%. The most effective combinations of levetiracetam were those with valproates and ethosuximide.

Efficacy and tolerability of levetiracetam for pediatric refractory epilepsy

IntroductionLevetiracetam has a high tolerability and is effective against various seizure types and epilepsy syndromes. However, no study has specifically evaluated the efficacy of levetiracetam in children with refractory epilepsy based on magnetic resonance imaging (MRI) findings and the presence of intellectual disability (ID). MethodsWe retrospectively evaluated levetiracetam efficacy and safety in 49 pediatric patients who met the following inclusion criteria: (1) diagnosis of refractory epilepsy with first-line antiepileptic (AED) treatment ⩾2years, (2) younger than 20years old, and (3) received oral levetiracetam treatment for ⩾6months. We assessed the relationships of these outcomes with MRI findings and ID status. ResultsEighteen (37%) patients achieved a ⩾50% reduction in seizure frequency, and the majority (78%) had no remarkable side effects. Twenty-two (45%) patients had previously been treated with more than seven antiepileptic drugs prior to levetiracetam. Among 18 patients who achieved a ⩾50% reduction in seizure frequency, 13 and 5 had negative and positive MRI findings, and 9 and 9 had and did not have ID, respectively. ConclusionsOur findings suggest that even for intractable pediatric cases with symptomatic etiology (i.e., MRI lesion and ID), levetiracetam has favorable efficacy for refractory epilepsy with tolerable adverse effects.

Add-on Levetiracetam in Children With Refractory Epilepsy: A Systematic Review

Context: Recently, new anti-epileptic drugs are marketed to be used as an add-on to the traditional drugs in children with refractory epilepsy. Levetiracetam is a second-generation of new anti-epileptic drugs with unknown precise mechanism of action in brain and synaptic vesicle in children with drug resistant epilepsy. Herein, the efficacy and safety of add-on levetiracetam in children with refractory epilepsy is reviewed. Evidence Acquisition: A literature review was performed on efficacy and safety of add-on Levetiracetam in children with refractory epilepsy using international databases with the following terms: levetiracetam, refractory epilepsy, drug resistant epilepsy, seizures/epilepsy, children/pediatric. All articles related to add-on levetiracetam in children with refractory epilepsy written in English and published from 2000 to 2015 were included. The title and abstracts of 542 articles were assessed, of which, 488 were excluded. The full texts of the other 54 articles were assessed for relevance. Results: Of the nine eligible articles, 1036 patients aged ≤ 18 years were identified. Male patients (52%) were more prominent than female ones. Five articles reported that levetiracetam therapy appeared more effective against localization-related than generalized epilepsy. The dosage of levetiracetam ranged from 6 to 70 mg/kg/day, with a mean of 43.2 mg/kg/day based on the mean doses reported by four of nine reviewed articles. The mean duration of follow-up was 39 weeks (ranging from 8 144 weeks). Administration of levetiracetam was effective in 42.24% of the patients (responders with >50% decrease in seizure frequency), of whom 11.8% had become seizure free. The mean number of anti-epileptic drugs tried before introducing levetiracetam treatment was 4.4 (ranging 1 20). The most frequent side effects were psychological and behavioral changes (11.1%), followed by agitation (9.2%) and sleep disturbances (6.7%). Conclusions: The current review demonstrated that levetiracetam, as an add-on therapy, is an effective and well-tolerated antiepileptic drug, associated with reversible and no serious side effects, to control seizure frequency of childhood refractory epilepsy.

小児難治性てんかんにおけるtopiramate, lamotrigine, levetiracetamの追加治療の有効性と安全性の比較検討

小児難治性てんかんにおけるtopiramate, lamotrigine, levetiracetamの追加治療の有効性と安全性の比較検討

Levetiracetam: Pharmacological properties, safety and efficacy in the pediatric population with epilepsy

Age-specific distribution of epilepsy is bimodal, with the highest incidence being in childhood. Seizures can affect life as early as day one. There is a paramount variation of epilepsy in childhood and adolesence with regards to its etiology and prognosis. Antiepileptic drugs, being the mainstay of treatment, necessitates that their use in this vulnerable age group must be made after a thorough look into the available evidence. The data on levetiracetam (LEV), a second-generation antiepileptic, spans from randomized controlled trials to case reports in various pediatric epilepsy and epileptic syndromes. This review is a compilation and critical analysis of the data on the differences in the pharmacokinetic properties of LEV in children versus adults, drug-interactions, efficacy of LEV in various contexts, namely, as add-on, as monotherapy, in partial and generalized seizures, in specific epilepsy syndromes such as benign epilepsy with centrotemporal spikes, epileptic syndromes with contin- uous spike and wave during sleep, Lennox-Gastaut syndrome, Jeavons syndrome and epilepsy associated with tuberous sclerosis. LEV is an effective option for the treatment of partial-onset seizures as both an add-on in refractory epilepsy and monotherapy in newly diagnosed focal epilepsies. There are preliminary but promising data available on various epileptic syndromes and epi- leptic encephalopathies that can nudge researchers towards further work in these areas in order to generate evidences that is more substantial. The safety and tolerability profile of LEV is favorable, though, behavioral and neuropsychiatric adverse events are reportedly higher in children versus adults. The neuropsychiatric adverse events are often observed against the background of previously existing behavioral issues and neurocognitive impairments.

Levetiracetam (Keppra) efficacy and safety in the prevention of early-onset seizures following traumatic brain injuries in pediatric patients

AbstractIntroductionApproximately half a million emergency department visits for traumatic brain injury (TBI) by children and adolescents occur each year. One of the complications of TBI is early-onset seizure. Current guidelines recommend the use of phenytoin for prevention of seizures following a TBI; however, several drug interactions and adverse reactions are associated with its use. Despite studies demonstrating efficacy of levetiracetam in adult patients, the efficacy and safety of levetiracetam in children with TBI is unknown. The purpose of this study was to determine the efficacy and safety of levetiracetam for the prevention of early-onset seizures in pediatric patients following TBI.MethodsA retrospective evaluation was conducted, which included children, ages 0 to 17 years, admitted secondary to a nonpenetrating TBI and who received levetiracetam for seizure prophylaxis for up to 7 days. The primary outcome was the number of children who had a seizure within the first 7 days following a TBI, and secondary outcomes included the number of adverse drug reactions.ResultsA total of 89 pediatrics patients with nonpenetrating TBI were identified and included in the study. Forty-seven patients received a mean dose of 10 mg/kg (SD ± 4.22) of levetiracetam twice a day, and 42 patients received 500 mg 2 times per day (based on adult dosing). Seizure activity was observed in only two patients (2.2%) within the first 7 days following TBI. A total of 13 patients (14.6%) experienced anemia, agitation, and elevation of liver enzymes during levetiracetam therapy.DiscussionThe study suggests that levetiracetam appears to be an effective and safe agent for early-onset seizure prophylaxis in pediatric patients with TBI as indicated by the low number of patients with seizures. The reported adverse reactions may have resulted from the trauma rather than the use of levetiracetam.

Efficacy and Safety of IV Levetiracetam in Children With Acute Repetitive Seizures

BackgroundLevetiracetam has been proven to be effective in both partial and generalized seizures in children. However, few studies have reported its efficacy in the treatment of acute repetitive seizures. We aimed to investigate the efficacy and safety of levetiracetam in children with acute repetitive seizures. MethodsThe medical records of children from the age of 1 month-18 years who received levetiracetam because of acute repetitive seizures in the pediatric intensive care unit between 2010 and 2013 were reviewed retrospectively. ResultsOf the 133 patients, levetiracetam terminated seizures in 104 (78.2%). Side effects such as agitation and aggression were observed in three patients (2.2%). The likelihood of treatment failure was increased by four times by younger age at seizure onset; by six times in the individuals with neurological abnormalities; and by 22 times in the patients with West syndrome. The patients who used levetiracetam as the first treatment option for acute repetitive seizures had a longer duration of epilepsy, a higher rate of neurological abnormality, and a higher proportion of medically resistant epilepsy compared with the individuals who used levetiracetam as an add-on treatment to the other intravenous antiepileptic drugs. However, no differences were detected between these two groups in terms of treatment response. ConclusionsIntravenous levetiracetam appears to be effective and safe in the treatment of acute repetitive seizures. Randomized clinical trials are needed to determine whether intravenous levetiracetam may replace other antiepileptic drugs as the first-line therapy in the management of acute repetitive seizures.

Role of intravenous levetiracetam in acute seizure management.

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