Efficacy of levetiracetam in the treatment of Sydenham chorea

Abstract

Background: To study the effect of levetiracetam in treating Sydenham chorea. Methods: We retrospectively collected the data of 140 patients diagnosed with Sydenham chorea in the pediatric neurology and pediatric cardiology outpatient clinics of Van Training and Research Hospital between January 2010 and December 2018. Results: There were 140 patients, 102 (70%) of whom were girls, with mean age of onset 11.8 AE 2.7 years. Symptomatic treatment was initiated in all patients at the time of diagnosis; this medication was changed during follow up in 15 patients. The most frequently prescribed drugs were haloperidol and sodium (Na) valproate, and the most frequently discontinued one was haloperidol, due to side effects. The second-choice drug was most often levetiracetam. Clinical response often began within the first 2 weeks, with Na valproate (P = 0.002), within 4 weeks with carbamazepine (P = 0.037) but 1-6 months with haloperidol (P = 0.018) and levetiracetam (P = 0.008). Time to full remission was similar with Na valproate, carbamazepine, haloperidol, and levetiracetam (P = 0.276). Our study indicated that levetiracetam was as effective as the other commonly used drugs in the symptomatic treatment of Sydenham chorea. Conclusion: Levetiracetam might be an option in the treatment of Sydenham chorea because of its acceptable effect and safety profile. This observation needs further support with evidence obtained through controlled and blinded trials.

Managing and treating Sydenham chorea: A systematic review

“…After removing duplicates and irrelevant studies, 50 underwent screening. These studies were then fully assessed via full‐text reviews, after which 11 fulfilled our inclusion criteria and thus remained (Araujo et al., 2002; Demiroren et al., 2007; Direk et al., 2020; Favaretto et al., 2020; Garvey et al., 2005; Gebremariam, 1999; Genel et al., 2002; Kulkarni & Anees, 1996; Orsini et al., 2022; Paz et al., 2006; Peña et al., 2002). The result of our literature search is summarized in the PRISMA flowchart, illustrated in Figure 1.…”

“…In a retrospective study from 2020, a total of 40 patients out of 140 chose haloperidol as their first drug of choice and decided to remain on it even after experiencing side‐effects (Direk et al., 2020). Haloperidol had the highest number of patients showing side‐effects, with four showing dizziness and four experiencing drowsiness (Direk et al., 2020).…”

Sydenham Chorea On Indonesian 10 Years Old Boy Caused By Rheumatic Heart Disease : Case Report And Literature Review

“…1 Various drugs have been used to treat chorea, such as dopamine receptor antagonists (eg, haloperidol), antiepileptic drugs (eg, valproic acid or carbamazepine). [4][5][6][7][8] Studies that examine these drugs in SC patients are very limited and the studies are often observational, objective outcome measures are limited, and the study population is heterogeneous, so the best treatment options are uncertain. We present an Indonesian 10-year-old boy with SC that completely recovered with outpatient management.…”

Oxcarbazepine May Be Useful in Sydenham Chorea

“… 4 In recent years, LEV is effective in the treatment of SC. Direk et al 7 reported that the effect of LEV started after 2 weeks because slow titration with the consideration of potential psychiatric side effects delayed the effect of the treatment. Levetiracetam acts through the synaptic vesicle protein 2A.…”

“…Especially in patients with SC, after the movement problems are improved with LEV, psychiatric problems such as anxiety, depression, concentration, and processing speed difficulty persist at a high rate. 7 , 8 These potential side effects limit the use of LEV in cases with SC.…”