Intravenous Levetiracetam for Epileptic Seizure Emergencies in Older People

Abstract

Purpose and Background: Clinical experience with intravenous levetiracetam (LEV IV) is still very limited, especially in elderly subjects. The primary objective of this retrospective observational study was to describe the efficacy and tolerability of LEV IV in older patients presenting with epileptic seizure emergencies. Methods: Medical records of 14 older people treated with LEV IV were analysed retrospectively. All patients suffered from series of complex partial seizures or convulsive or non-convulsive status epilepticus needing emergent intravenous (IV) antiepileptic drug (AED) treatment. Nine patients were taking AED therapy when LEV IV was administered. Results: Mean age was 73.9 years (range 61–97). Mean dosage was 1,643 mg/day (range 500–4,000). Seizure control could be achieved in 11/14 patients (78.6%). No significant adverse events were noted besides sedation. Conclusion: LEV IV was effective and well tolerated in these critically ill older patients. LEV IV seems to be a reasonable practical alternative in multimorbid older patients who need IV treatment with an AED.

Status epilepticus in the elderly: epidemiology, clinical aspects and treatment

“…6,52 In a retrospective observational study of 14 older patients (age range 61–97 years), complete seizure control was achieved with relatively low doses of LEV (mean 1.643 mg±949.3 mg/day) in 78.6% of patients and no serious side effects, except somnolence, were observed. 53 One study reports the occurrence of NCSE in 2 patients treated with LEV 2000 mg. 54 LEV can be effective in the treatment of SE, and seems to be a reasonable practical alternative to multimorbid older patients who need i.v. treatment with an AED, although clinical experience is still very limited, especially in this patient population.…”

Levetiracetam Rectal Administration in Healthy Dogs

“…The drug has since gained broader approvals for treatment of a variety of partial and generalized seizure conditions, including those in pediatric patients 13, 14. Levetiracetam has a therapeutic profile closer to ideal than most other anticonvulsants15 and the parenteral form is now used increasingly to manage cluster seizures and status epilepticus in the very young, elderly, and critically ill humans 16, 17, 18, 19, 20…”

Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients: A prospective randomized study

“…LEV is highly effective as therapy for both focal and primarily generalized epilepsy with novel mode of action binding to synaptic vesicle protein 2A, linear kinetics, few serious side effects and minimal drug‐drug interaction, although utility in early status epilepticus (SE) is theoretically limited by comparatively slower brain entry (Crepeau & Treiman, 2010). Intravenous LEV is in off‐label use in patient groups potentially more suited to its pharmacokinetics and favorable tolerability (Ramael et al., 2006; Beyenburg et al., 2009; Szaflarski et al., 2010).…”