Levetiracetam: A Practical Option for Seizure Management in Elderly Patients With Cognitive Impairment

Lippa, Carol F.; Rosso, Andrea L.; Hepler, M; Jenssen, Sigmund; Pillai, Jyoti; Irwin, David J.

doi:10.1177/1533317508325095

Cited by 39 publications

(28 citation statements)

References 22 publications

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“…In AD, studies are available on levetiracetam (LEV), lamotrigine (LTG), gabapentin, carbamazepine, valproic acid, phenytoin, and phenobarbital (Horváth et al, 2016;Vossel et al, 2017). Only LEV and LTG reached excellent efficacy (60-70% reduction in the number of seizures in a 1-year follow-up) and tolerability without cognitive side effects (Belcastro et al, 2007;Cumbo and Ligori, 2010;Lippa et al, 2010). Notably, treatment with LEV resulted in marginally increased cognitive scores (MMSE and ADAS-Cog), and application of LTG was associated with significantly improved mood (Cumbo and Ligori, 2010), but the study was not placebo controlled.…”

Section: Therapeutic Aspects Current Findings and Recommendationsmentioning

confidence: 99%

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

et al. 2020

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Cognitive impairment is a common and seriously debilitating symptom of various mental and neurological disorders including autism, attention deficit hyperactivity disorder, multiple sclerosis, epilepsy, and neurodegenerative diseases, like Alzheimer's disease. In these conditions, high prevalence of epileptiform activity emerges as a common pathophysiological hallmark. Growing body of evidence suggests that this discrete but abnormal activity might have a long-term negative impact on cognitive performance due to neuronal circuitries' remodeling, altered sleep structure, pathological hippocampocortical coupling, and even progressive neuronal loss. In animal models, epileptiform activity was shown to enhance the formation of pathological amyloid and tau proteins that in turn trigger network hyperexcitability. Abolishing epileptiform discharges might slow down the cognitive deterioration. These findings might provide basis for therapeutic use of antiepileptic drugs in neurodegenerative cognitive disorders. The aim of our review is to describe the data on the prevalence of epileptiform activity in various cognitive disorders, to summarize the current knowledge of the mechanisms of epileptic activity in relation to cognitive impairment, and to explore the utility of antiepileptic drugs in the therapy of cognitive disorders. We also propose future directions for drug development and novel therapeutic interventions targeting epileptiform discharges in these disorders.

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Section: Therapeutic Aspects Current Findings and Recommendationsmentioning

confidence: 99%

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

et al. 2020

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“…A blinded study showed recent memory improved most in patients with poor baseline scores [Huang et al 2008]. In addition, at least two studies have reported improvements on the Mini-Mental State Examination with use [Lippa et al 2010;Wu et al 2009], one of these in elderly patients with cognitive impairment [Lippa et al 2010].…”

Section: Levetiracetammentioning

confidence: 99%

The cognitive impact of antiepileptic drugs

Eddy¹,

Rickards²,

Cavanna³

2011

Ther Adv Neurol Disord

319

189

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Effective treatment of epilepsy depends on medication compliance across a lifetime, and studies indicate that drug tolerability is a significant limiting factor in medication maintenance. Available antiepileptic drugs (AEDs) have the potential to exert detrimental effects on cognitive function and therefore compromise patient wellbeing. On the other hand, some agents may serve to enhance cognitive function. In this review paper, we highlight the range of effects on cognition linked to a variety of newer and older AEDs, encompassing key alterations in both specific executive abilities and broader neuropsychological functions. Importantly, the data reviewed suggest that the effects exerted by an AED could vary depending on both patient characteristics and drug-related variables. However, there are considerable difficulties in evaluating the available evidence. Many studies have failed to investigate the influence of patient and treatment variables on cognitive functioning. Other difficulties include variation across studies in relation to design, treatment group and assessment tools, poor reporting of methodology and poor specification of the cognitive abilities assessed. Focused and rigorous experimental designs including a range of cognitive measures assessing more precisely defined abilities are needed to fill the gaps in our knowledge and follow up reported patterns in the literature. Longitudinal studies are needed to improve our understanding of the influence of factors such as age, tolerance and the stability of cognitive effects. Future trials comparing the effects of commonly prescribed agents across patient subgroups will offer critical insight into the role of patient characteristics in determining the cognitive impact of particular AEDs.

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“… 1 Levetiracetam (LEV) has proven to be a good option because it presents linear pharmacokinetics, renal excretion (therefore less drug interaction), is broad spectrum (used in generalized and focal seizures), while some studies have also shown some degree of benefit in cognitive function. 28 - 30 However it is important to mention that the main concerns with LEV are behavioral side effects, most commonly depression, with a prevalence of approximately 7%. 1 …”

Section: Resultsmentioning

confidence: 99%

Epilepsy in patients with Alzheimer's disease: A systematic review

Miranda

Brucki

2014

Dement. neuropsychol.

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Alzheimer's disease (AD) and epilepsy are common disorders in the elderly. Evidence demonstrates that patients with AD have an increased risk of developing epilepsy and seizures.ObjectiveTo review epidemiological, clinical and treatment aspects of epilepsy and AD.MethodsWe reviewed databases (PubMED, LiLACS, Scielo) conducting a search for manuscripts using the terms Alzheimer's disease and epilepsy.ResultsManuscripts related to the areas of interest were reviewed. Studies revealed that epilepsy is more frequent among AD patients. The combined presence of the two disorders may be related to mechanisms of neuronal hyperexcitability as a consequence of amyloid-beta protein (Aβ) or phosphorylated tau accumulation, as well as to structural changes in cortical and hippocampal regions. Available data suggest that the new generation of antiepileptic drugs (AEDs) are better tolerated in the elderly population, and may also be the best option in patients with AD and epilepsy.ConclusionFurther prospective studies involving evaluation of concomitant dementia and epilepsy, neurophysiological findings and biomarkers need to be performed.

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Levetiracetam: A Practical Option for Seizure Management in Elderly Patients With Cognitive Impairment

Cited by 39 publications

References 22 publications

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

The cognitive impact of antiepileptic drugs

Epilepsy in patients with Alzheimer's disease: A systematic review

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