Clinical Use and Efficacy of Levetiracetam for Absence Epilepsies

Abstract

Background: Levetiracetam is prescribed for a broad spectrum of seizure types but does not have a specific indication for absence epilepsy. We hypothesized that levetiracetam is commonly prescribed for children with absence epilepsies and evaluated the efficacy of this medication for absence epilepsy treatment in clinical practice. We also hypothesized that electroencephalographic (EEG) findings could help predict levetiracetam efficacy. Methods: We reviewed the charts of all patients treated for new-onset absence epilepsies at our pediatric neurology clinic between January 2011 and January 2016. Among 158 children diagnosed with absence epilepsies, 72 were treated with levetiracetam. Results: Levetiracetam was discontinued in 74% (n ¼ 53/72) because of incomplete seizure control (59%, n ¼ 35/72) and/or intolerable side effects (41%, n ¼ 24/72) after a median 8.5 months (interquartile range 2, 17 months). Among patients for whom levetiracetam was effective, 44% (n ¼ 8/18) had polyspikes on their initial EEG, versus 27% (n ¼ 14/52) of patients for whom levetiracetam was discontinued (P ¼ .17). The maximal prescribed dose was lower for children in whom levetiracetam was effective (29 + 13 mg/kg/d) than those for whom levetiracetam failed (42 + 20 mg/kg/d; P ¼ .005). Conclusion: In routine clinical practice, levetiracetam is often chosen for patients with absence seizures. However, only about one-quarter of children with absence epilepsy in this study became seizure free with levetiracetam. When effective, levetiracetam can control absence epilepsy at a relatively low dose. Lack of seizure control requiring continued dose escalation should prompt early consideration of a therapeutic medication transition.

Clinical and Electrophysiological Characteristics of Patients with Juvenile Absence Epilepsy in a Turkish Cohort

“…and the risk of teratogenicity for girls who come to the reproductive age should be kept in mind. Although the most effective drug in alternative treatment is lamotrigine for now, the increasing frequency of levetiracetam use is also striking (18)(19)(20).…”

Response of spike-wave discharges in aged APP/PS1 Alzheimer model mice to antiepileptic, metabolic and cholinergic drugs

“…The strongest argument for validating rodent SWDs as a model of human absence seizures is the similar response to AEDs of these conditions. Ethosuximide is a drug-of-choice for human absence seizure while AEDs effective for generalized seizures, including levetiracetam, show only modest effect at best 31 . In partial agreement with the clinical experience, we found ethosuximide effective against SWDs in aged APP/PS1 mice during the mixed state but being neutral in sleep and waking immobility.…”

Pharmacodynamic rationale for the choice of antiseizure medications in the paediatric population

“…Not surprisingly, LTG and VPA are the drugs of choice, together with ETH, for the treatment of CAE [ 49 ]. In clinical practice, a fair proportion of patients ranging from 25% to 50% appear to respond to LEV monotherapy as well, although a seizure-worsening effect is reported in a non-negligible portion [ [50] , [51] , [52] ].…”