Adjunctive levetiracetam in infants and young children with refractory partial‐onset seizures

Piña-Garza, J. Eric; Nordli, Douglas R.; Rating, D.; Huang, Yang; Schiemann-Delgado, Jimmy; Duncan, Benjamin

doi:10.1111/j.1528-1167.2008.01981.x

Cited by 103 publications

(112 citation statements)

References 33 publications

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“…Similar findings were observed by others (13,18). Opp et al reported 24.9% of the responders with more than 50% of seizure reduction during LEV therapy that was less than the current review results (2).…”

Section: Discussionsupporting

confidence: 79%

“…They concluded that the lower response rates they observed might be because of insufficient experience with LEV in young children, resulting in a very strong selection bias for infants with highly refractory epilepsies (15). On the contrary, Pina-garza et al reported that adjunctive levetiracetam was an effective and well-tolerated treatment for partial-onset seizures inadequately controlled with one or two antiepileptic drugs in children aged one month to less than four years (18).…”

Section: Discussionmentioning

confidence: 99%

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

Abbaskhanian

Shahmohammadi

2016

J Pediatr Rev

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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.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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

Abbaskhanian

Shahmohammadi

2016

J Pediatr Rev

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“…Another multicenter, double-blind, randomized, placebo-controlled Class II study evaluated the efficacy and tolerability of adjunctive LEV in infants and younger children (aged 1 month to <4 years) with partial-onset seizures inadequately controlled with <2 AEDs [20]. This study consisted of a 48-h inpatient baseline video-EEG and a 5-day inpatient treatment period (1-day up-titration; 48-h evaluation video-EEG in the last 2 days).…”

Section: Resultsmentioning

confidence: 99%

Pharmacotherapy of Focal Epilepsy in Children: A Systematic Review of Approved Agents

Arya

Glauser

2013

CNS Drugs

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Background Partial-onset seizures contribute the bulk of seizure burden in childhood epilepsy. The therapeutic decision making involves consideration of factors specific to drug, patient and socioeconomic situation. Objectives This paper systematically reviews the available efficacy/effectiveness evidence for various anti-epileptic drugs (AED) as monotherapy and adjunctive therapy for partial-onset seizures in children. Data sources Relevant randomized clinical trials (RCTs) were identified by a structured PubMed search, supplemented by an additional hand search of reference lists and authors’ files. Study appraisal and synthesis methods Eligible studies were reviewed and data extracted into tables. Included RCTs were classified based on accepted published criteria. Outcomes Only efficacy and effectiveness outcome measures were evaluated since there is little scientifically rigorous comprehensive AED adverse effects data. Results Oxcarbazepine is the only AED with Class I evidence for efficacy/effectiveness as initial monotherapy for partial-onset seizures in children. Carbamazepine, clobazam, lamotrigine, phenobarbital, phenytoin, topiramate, valproate, vigabatrin and zonisamide have, at best, Class III efficacy/effectiveness evidence for monotherapy of partialonset seizures in children. For adjunctive therapy, gabapentin, lamotrigine, levetiracetam, oxcarbazepine and topiramate have Class I efficacy/effectiveness evidence for treatment of pediatric partial-onset seizures. Conclusions and implications of key findings This efficacy/effectiveness analysis must not be used in isolation when selecting therapy. AED selection for a specific child needs to integrate a drug’s efficacy/effectiveness data with its safety and tolerability profile, pharmacokinetic properties, available formulations, and patient specific characteristics. It is critical that physicians and patients incorporate all these relevant variables when choosing AED therapy.

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“…The wide broad spectrum of activity of LEV is supported by various double-blind studies that demonstrated its effectiveness and safety as add-on therapy in generalized epilepsies, such as myoclonic seizures [25], or primary generalized tonic-clonic seizures [4], and in partial-onset seizures [15,31]. The FDA approved LEV as an adjunctive therapy for partial onset seizures in adults and children ≥4 years of age, adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents ≥12 years of age with juvenile myoclonic epilepsy and as adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children ≥6 years of age with idiopathic generalized epilepsy.…”

mentioning

confidence: 99%