Carbamazepine versus levetiracetam in epilepsy due to neurocysticercosis

Abstract

Background The choice of antiepileptic drug (AED) in newly diagnosed neurocysticercosis (NCC) patients with epilepsy continues to be arbitrary. We compared efficacy and side effect profile of levetiracetam (LEV) and carbamazepine (CBZ) for the treatment of seizures in newly diagnosed patients with NCC. Patients and methods This was an open‐labeled randomized comparative monotherapy study including newly diagnosed drug naïve patients of NCC (n = 99) presenting with seizures who were randomized in 1:1 ratio using computed generated numbers. All patients were followed up for at least six months after start of treatment. The primary outcome measure was seizure control over six months following start of AEDs. Results Fifteen (15.2%) patients [CBZ‐ 4(8.2%); LEV‐ 11(22%)] developed recurrence of seizures. A trend (p = 0.09) was found toward better control of seizures in CBZ compared to LEV. Two (4%) patients in LEV group and 17 (34.6%) patients in CBZ group developed drug‐related minor side effects (p < 0.0001). Three patients in CBZ group needed discontinuation of therapy due to skin rash. Eleven patients who relapsed while on LEV did not have any recurrence of seizures after switching over to CBZ. Out of 3 patients who relapsed while receiving CBZ and were changed to LEV, two developed seizures during follow‐up. Conclusion CBZ and LEV could be used as alternatives in newly diagnosed patients of NCC at the behest of minor side effects in the CBZ group.

Neurocysticercosis: A neglected but preventable cause of seizure in adults

“…Acute symptoms like seizures and increased intracranial pressure should be treated first before initiation of anthelmintic therapy. Carbamazepine, phenytoin or levetiracetam should be given even in the case of a single episode of seizure since lesions serve as a focus for recurrent seizures 2,10,14 . Levetiracetam has fewer side effects and is also better tolerated but the first patient could not afford it.…”

Neurocysticercosis in non-endemic regions: The experience of Qatar

“…According to the latest reviews and guidelines, antihelmintic therapy is recommended for potentially viable parenchymal NCC. Albendazole alone or in combination with Praziquantel seem to enhance the destruction of parasitic cysts and may lead to fewer seizure recurrences (31)(32)(33)(34). Phenytoin was the most prescribed ASM (57%).…”

“…The current literature does not offer any strong evidence for the choice of ASM in the context of NCC. We found a single open label study comparing carbamazepine and levetiracetam; although there was a trend for better seizure control with carbamazepine, patients treated with the later experienced a higher rate of drug related side effects ( 35 ). There is no reliable evidence regarding the duration of ASM treatment either, with the persistence of calcified lesions predicting a higher risk for seizure recurrence ( 1 , 32 , 36 ).…”

Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy

“…There is no evidence that treatment should be different from other epilepsy causes. One study asserts no difference in efficacy between carbamazepine and levetiracetam, 49 although some methodological aspects of this study were raised after its publication. 50 A recent study in children with solitary viable parenchymal cysts showed similar efficacy with fewer adverse effects of lacosamide compared to oxcarbazepine.…”