Comparison between flunarizine and levetiracetam in paediatric migraine prophylaxis

Rahman, Sk Masiur; Kundu, Gopen Kumar; Fatema, Kanij; Akhter, Shaheen; Rahman, Mizanur

doi:10.3329/bmjk.v51i1-2.40472

Cited by 3 publications

(4 citation statements)

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“…[15][16][17] Baseline pain intensity (PedMIDAS) score was decreased significantly after four months treatment with both drugs which correlates with a Bangladeshi study where baseline headache days has reduced significantly after three months treatment with FNZ (p < 001). 18 In this current study, side effects of drugs were mild and comparable in both treatment group (p=0.387) which was similar with different randomized controlled trials. 12,16,19 Conclusion: TPM (Topiramate) is as efficacious and tolerable as FNZ (Flunarizine) in the prophylactic treatment of paediatric migraine.…”

Section: Discussionsupporting

confidence: 88%

Efficacy of Topiramate as Prophylactic Treatment of Severe Migraine in Children attending OPD of a Tertiary Care Hospital in Bangladesh- a Randomized Control Trial

Mistry

Begum

Saha

et al. 2021

Bangladesh J Child Health

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Background: Migraine is the most common cause of severe recurrent headache in children. Flunarizine (FNZ) is safe and effective drug for prevention of migraine in children. Topiramate (TPM) is also successful as a preventive drug for migraine in children on randomized, double-blind, placebo-controlled trials. Objective: This study was done to observe the efficacy of Topiramate and also perform a comparison TPM and FNZ in patients with migraine of severe intensity in our situation. Materials & Methods: This was a randomized controlled trial done from January to July, 2018. This study was carried out in the OPD of Paediatric Neurology department, National Institute of Neurosciences, (NINS) Dhaka. Forty Children, 5-15 years old diagnosed as migraine with/without aura with severe intensity were randomized either as in study group (TPM treatment group) and control group (FNZ treatment group). Primary end point of the study was to find out the efficacy and safety of both TPM and FNZ after 4 months of treatment. Result: Post-treatment frequency of headache/month was significantly decreased in both groups (within group, p <0.001). There was no significant difference considering pre and post-treatment frequency of headache/month between two treatment groups. (pre-treatment p- 0.333 and post-treatment p- 0.401). Adverse events were not significantly different between the groups p<0.387. Conclusion: Topiramate is equally efficacious as Flunarizine in prophylactic treatment of severe migraine in children. Bangladesh J Child Health 2020; VOL 44 (3) :153-156

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Section: Discussionsupporting

confidence: 88%

Efficacy of Topiramate as Prophylactic Treatment of Severe Migraine in Children attending OPD of a Tertiary Care Hospital in Bangladesh- a Randomized Control Trial

Mistry

Begum

Saha

et al. 2021

Bangladesh J Child Health

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“…In children, aged 0.5 to 14 years, levetiracetam is rapidly absorbed following oral dosing and the mean total body clearance and distribution volume are 1.04 L/h and 12.1 L, respectively [25]. The prophylaxis with levetiracetam has been studied in infants and children [26][27][28][29]. Levetiracetam is effective as flunarizine in the prophylaxis of migraine in paediatric patients [26], levetiracetam and phenytoin have similar effectiveness for prevention of seizure induced by busulfan [27], levetiracetam and (fos) phenytoin are similarly effective in preventing early post-haemorrhagic seizures in infants and children [28], and prophylactic levetiracetam reduces the incidence of seizures in children after severe traumatic brain injury [29].…”

Section: Discussionmentioning

confidence: 99%

“…The prophylaxis with levetiracetam has been studied in infants and children [26][27][28][29]. Levetiracetam is effective as flunarizine in the prophylaxis of migraine in paediatric patients [26], levetiracetam and phenytoin have similar effectiveness for prevention of seizure induced by busulfan [27], levetiracetam and (fos) phenytoin are similarly effective in preventing early post-haemorrhagic seizures in infants and children [28], and prophylactic levetiracetam reduces the incidence of seizures in children after severe traumatic brain injury [29]. The treatment of infants and children with levetiracetam has been extensively studied [30][31][32][33][34][35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Pharmacology of Levetiracetam in Infants and Children

Pacifici¹

2022

JCLR

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Levetiracetam inhibits focal and secondary generalized tonic-clonic seizures. The mechanism of levetiracetam action is not fully understood, however the correlation between binding affinity of levetiracetam and its analogues and their potency toward audiogenic seizures suggest that the synaptic vesicle glycoprotein 2A mediates the anticonvulsant effects of levetiracetam. The neural function of the synaptic vesicle 2A protein is not fully understood, but binding of levetiracetam to synaptic vesicle glycoprotein 2A might affect neuronal excitability by modifying the release of glutamate GABA through an action on vesicular function. Synaptic vesicle glycoprotein 2A may plain a role in vesicle recycling following exocytosis of neurotransmitter. In addition, levetiracetam inhibits N-type Ca2+ channels and Ca2+ release from intracellular stores. Levetiracetam may be administered intravenously or orally to infants and children and in children the levetiracetam dose varies according to the child age and body-weight. Levetiracetam is almost completed absorbed after oral administration and levetiracetam is found efficacy and safe in infants and children but it may induce adverse-effects. The levetiracetam elimination half-life is about 6 hours in infants and children, and in children the renal clearance is similar to the non-renal clearance. The prophylaxis, treatment, and trials with levetiracetam have been extensively studied in infants and children. Levetiracetam freely crosses the human placenta and freely migrates into the breast-milk. The aim of this study is to review the levetiracetam dosing, efficacy, safety, adverse-effects, pharmacokinetics, prophylaxis, treatment, and trials and transfer of levetiracetam across the human placenta and levetiracetam migration into the breast-milk.

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Efficacy and safety of levetiracetam for migraine prophylaxis in children: a systematic review and meta-analysis

Peng,

Liu,

et al. 2024

Front. Pharmacol.

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BackgroundLevetiracetam (LEV), an antiepileptic drug, has been effective in adult migraine prevention but lacks extensive research in children. This study evaluates LEV’s efficacy and safety for pediatric migraine prophylaxis.MethodsWe reviewed randomized controlled trials (RCTs) and non-RCTs in major databases through 8 January 2024, focusing on four efficacy endpoints and adverse drug reactions (ADRs). Data synthesis involved pooled relative risks or odds ratios for dichotomous outcomes and mean differences for continuous outcomes, using fixed- or random-effects models as appropriate.ResultsEight studies with 190 participants showed that after taking LEV, the mean headache frequency decreased 5.19 per month (MD: −5.19, 95% CI: −7.11 to −3.27, p < 0.00001) and improved headache-free rates to 28% (95% CI: 0.17–0.41). More than 83% experienced a >50% reduction in monthly headache frequency. The migraine disability score decreased by 33.51 points (MD: −33.51, 95% CI: −38.46 to −28.55, p < 0.00001). ADR incidence did not significantly differ between LEV and control groups (RR: 1.06, 95% CI: 0.39 to 2.85, p = 0.91), with an overall ADR rate of 18% (95% CI: 0.13–0.24). The most common ADR was irritability (12%), leading to treatment discontinuation in 13% of cases (95% CI: 0.05–0.30).ConclusionLEV has shown good efficacy in preventing pediatric migraines. However, its safety requires further confirmation through more extensive and well-designed RCTs.Systematic Review RegistrationIdentifier PROSPERO CRD42024497643.

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Comparison between flunarizine and levetiracetam in paediatric migraine prophylaxis

Cited by 3 publications

References 14 publications

Efficacy of Topiramate as Prophylactic Treatment of Severe Migraine in Children attending OPD of a Tertiary Care Hospital in Bangladesh- a Randomized Control Trial

Efficacy of Topiramate as Prophylactic Treatment of Severe Migraine in Children attending OPD of a Tertiary Care Hospital in Bangladesh- a Randomized Control Trial

Clinical Pharmacology of Levetiracetam in Infants and Children

Efficacy and safety of levetiracetam for migraine prophylaxis in children: a systematic review and meta-analysis

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