Levetiracetam in children with refractory epilepsy: Lack of correlation between plasma concentration and efficacy

Giroux, Patricia; Salas-Prato, Milagros; Théôret, Yves; Carmant, Lionel

doi:10.1016/j.seizure.2009.05.007

Cited by 24 publications

(21 citation statements)

References 31 publications

(45 reference statements)

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“…Adverse events leading to LEV discontinuation included behavioral changes ( N = 3), gait disturbance ( N = 1), and depression ( N = 1) (83, 84). Two retrospective studies in pediatric patients reported LEV doses in 93 children ranging from 12.7 to 84 mg/kg/day with blood levels in responders ranging from 5 to 60 μg/mL (85, 86). None of these pediatric and adult studies reported dose – level – seizure response relationship.…”

Section: Resultsmentioning

confidence: 99%

Levetiracetam Use in the Critical Care Setting

DeWolfe¹,

Szaflarski²

2013

Front. Neurol.

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Intravenous (IV) levetiracetam (LEV) is currently approved as an alternative or replacement therapy for patients unable to take the oral form of this antiepileptic drug (AED). The oral form has Food and Drug Administration (FDA) indications for adjunctive therapy in the treatment of partial onset epilepsy ages 1 month or more, myoclonic seizures associated with juvenile myoclonic epilepsy starting with the age of 12 and primary generalized tonic-clonic seizures in people 6 years and older. Since the initial introduction, oral and IV LEV has been evaluated in various studies conducted in the critical care setting for the treatment of status epilepticus, stroke-related seizures, seizures following subarachnoid or intracerebral hemorrhage, post-traumatic seizures, tumor-related seizures, and seizures in critically ill patients. Additionally, studies evaluating rapid infusion of IV LEV and therapeutic monitoring of serum LEV levels in different patient populations have been performed. In this review we present the current state of knowledge on LEV use in the critical care setting focusing on the IV uses and discuss future research needs.

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Section: Resultsmentioning

confidence: 99%

Levetiracetam Use in the Critical Care Setting

DeWolfe¹,

Szaflarski²

2013

Front. Neurol.

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“…[11,12] Earlier studies have shown restricted benefi t of TDM in patients receiving levetiracetam and a clearcut margin for trough concentration in relation to clinical improvement has not been demonstrated. [10] Giroux and colleagues [13] have reported a lack of correlation between serum levetiracetam concentration and clinical effi cacy in the pediatric population. In this study 60% of the responders had serum concentration ranging from 5-40 μg/ml.…”

Section: Resultsmentioning

confidence: 99%

“…[13] difference in serum concentrations between inducers and inhibitors (P value=0.008) and also between inducers and those without interfering antiepileptic co-medication (P value= 0.004). However, the median levetiracetam dose in patients without interfering comedication, with inducers and with inhibitors was not signifi cantly different and was 40, 41.7 and 40 mg/ kg respectively.…”

Section: Discussionmentioning

confidence: 97%

An initial experience with therapeutic drug monitoring of levetiracetam as reported from a pediatric clinical setting in India

et al. 2012

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“…Second, dosing was not standardized, and it is unknown whether dosing was optimal as neonatal pharmacokinetic data are not available. A retrospective series of children with refractory epilepsy reported no correlation between plasma level and efficacy, 33 suggesting it may be difficult to identify an optimal dosing regimen. Third, while levetiracetam was associated with a greater than 50% reduction in seizures in 35% of neonates within 24 hours, this small retrospective uncontrolled study does not provide quality efficacy data and merely suggests future prospective study of levetiracetam effectiveness is warranted.…”

Section: Discussionmentioning

confidence: 99%

Levetiracetam for Treatment of Neonatal Seizures

et al. 2011

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Neonatal seizures are often refractory to treatment with initial antiseizure medications. Consequently, clinicians turn to alternatives such as levetiracetam, despite the lack of published data regarding its safety, tolerability, or efficacy in the neonatal population. We report a retrospectively identified cohort of 23 neonates with electroencephalographically confirmed seizures who received levetiracetam. Levetiracetam was considered effective if administration was associated with a greater than 50% seizure reduction within 24 hours. Levetiracetam was initiated at a mean conceptional age of 41 weeks. The mean initial dose was 16 ± 6 mg/kg and the mean maximum dose was 45 ± 19 mg/kg/day. No respiratory or cardiovascular adverse effects were reported or detected. Levetiracetam was associated with a greater than 50% seizure reduction in 35% (8 of 23), including seizure termination in 7. Further study is warranted to determine optimal levetiracetam dosing in neonates and to compare efficacy with other antiseizure medications.

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Levetiracetam in children with refractory epilepsy: Lack of correlation between plasma concentration and efficacy

Abstract: Levetiracetam given twice a day in children with refractory epilepsy reduces seizure frequency in all types of epilepsy. In children, LEV is a broad spectrum anticonvulsant with a favourable safety profile.

Cited by 24 publications

References 31 publications

Levetiracetam Use in the Critical Care Setting

Levetiracetam Use in the Critical Care Setting

An initial experience with therapeutic drug monitoring of levetiracetam as reported from a pediatric clinical setting in India

Levetiracetam for Treatment of Neonatal Seizures

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