A prospective open-labeled trial with levetiracetam in pediatric epilepsy syndromes: Continuous spikes and waves during sleep is definitely a target

Abstract

Although LVT is currently extensively prescribed in childhood epilepsy, its effect on the panel of refractory epilepsy syndromes has not been entirely evaluated prospectively. In order to study the efficacy and safety of LVT as adjunctive therapy according to syndromes, we included 102 patients with refractory seizures (6 months to 15 years) in a prospective open-labeled trial. The responder rate was respectively 36% and 32% at 3 and 6 months with 6% and 7% patients becoming seizure free. Among the responders at 6 months (n=33), seizure frequency decreased by 66% and 79% at 3 and 6 months LVT compared to baseline. The highest benefit was for CSWS patients with 2/3 responders, 50% seizure free and no aggravation. LVT provided respectively 39% and 42% responders in focal and absence epilepsies. Infantile spasms and Dravet syndrome experienced the lowest efficacy. No patient with myoclonic-astatic epilepsy or Lennox-Gastaut syndrome was aggravated. LVT dose over 40 mg/kg/d was associated with a lower response rate. Tolerability was excellent. In spite of a small sample, we assume that CSWS is a good candidate for a randomized-controlled trial with LVT.

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

“…Increasing the dose of CLB dose was effective for seizure control and NCSE cessation, although benzodiazepines have been reported to occasionally aggravate tonic seizures [1,10]. The major side effects of LEV have been reported to be mostly mild and transient in nature, and include irritability, aggression and somnolence [3][4][5][6]10]. Recently, however, some patients with refractory childhood epilepsy (e.g.…”

“…In contrast, levetiracetam (LEV) is novel anticonvulsants with diminished risks for harmful risks for drug-drug interactions because of its lack of interference with the metabolism of other drugs [3][4][5][6]. Its efficacy and tolerability with regard to improvement in patient' QoL and seizure-control in various refractory epilepsies, including LGS, have been evaluated in several reports [5,7,8].…”

“…Its efficacy and tolerability with regard to improvement in patient' QoL and seizure-control in various refractory epilepsies, including LGS, have been evaluated in several reports [5,7,8]. LEV was recently approved also in Japan as a monotherapy for focal seizure, or as adjunctive therapy for generalized tonic onset seizures in both adults and children older than 4 years of age.…”

Treatment-resistant Lennox-Gastaut syndrome: therapeutic trends, challenges and future directions

“…Levetiracetam demonstrated efficacy in small cohorts of patients with LGS and remains a common choice due to an exemplary safety and tolerability profile 31,32…”

Successful, Short-Term Drug Exchange Protocol in Epilepsy: Transient Addon of Intravenous Anti-Epileptic Drugs

“…For intractable epileptic patients, administration of other drugs sometimes spoils their quality of life (QOL). Newer AEDs, such as Gabapentin (GPT), Topiramate (TPM), Lamotrigine (LTG), Levetiracetam (LEV), and Rufinamide (RFN) have been readily available in Japan since 2006,2007,2008,2010, and 2013, respectively, and the high efficacy of these AEDs in the treatment of intractable epileptic patients has been reported [2][3][4][5]. When a newer AED is introduced, it does not have the desired effect when used with several other AEDs [6,7]; physicians often attempt, therefore, to decrease the total number of AEDs before adding another drug, but a reduction in oral AED can potentially cause seizure exacerbation, e.g., frequent seizures, status epilepticus, and sudden unexpected death in epileptic patients [8].…”