Levetiracetam in juvenile myoclonic epilepsy: long‐term efficacy in newly diagnosed adolescents

Abstract

The aim of this study was to evaluate the efficacy and tolerability of levetiracetam (LEV) monotherapy in juvenile myoclonic epilepsy (JME). The study group consisted of 32 patients with epilepsy (20 males, 12 females) with a mean age of 13 years 3 months (SD 7y 11mo) at seizure onset. LEV was administered as the first drug; all patients were followed up at 6 and 12 months. The dose that achieved seizure control ranged from 1000 to 2500mg/daily. At 6-month evaluation: 15 patients were seizure free; 14 patients were responders (>50% reduction in seizures); and three patients had marginal effects (<50% reduction of seizures). At 12-month evaluation: 29 patients were seizure free; three patients were responders. No patients reported adverse events. These data provide preliminary evidence that LEV may be effective for treating patients with newly diagnosed JME.Juvenile myoclonic epilepsy (JME) is an idiopathic generalized epilepsy, characterized by irregular myoclonic jerks, tonicclonic seizures, and sometimes typical absences. 1 The main clinical symptoms of JME are myoclonic jerks on awakening, generalized tonic-clonic seizures, typical absences, and photosensitivity. 1,2 This type of epilepsy generally responds to antiepileptic drugs (AEDs) and is, therefore, generally considered a benign type of epilepsy. 3 Physicians have at their disposal many AEDs to treat JME; historically, valproic acid was the first AED used to treat myoclonic seizures, 4 but levetiracetam (LEV) could be a good alternative because of its efficacy against all three JME seizure types and photosensitivity, and because of lack of the endocrine and metabolic side-effects frequently reported in patients receiving valproic acid. 5,6 LEV is a novel AED because its mechanisms of action appear different from other AEDs and seem to be unrelated to known mechanisms of neurotransmission. In fact, it has no significant affinity for gamma-aminobutyric acidergic or glutamatergic receptors and does not interact directly with the benzodiazepine binding site. 7 LEV seems to partially inhibit N-type high voltage-activated Ca 2+ currents and reduces Ca 2+ release from intraneuronal stores; it reverses the effects of negative allosteric modulators of gamma aminobutyric acid and glycine-gated currents. [8][9][10] Recently, the LEV binding site was identified as synaptic vesicle protein 2A (SV2A). 11 A very recent study 12 has explored the hypothesis that the antiepileptic mechanism of action of LEV is related to effects on alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor channels in mouse cortical neurons. This study reveals that AMPA receptors are modulated by LEV because a significant decrease was found in the kainate and AMPA-induced miniature excitatory postsynaptic currents in cortical neurons.Several reports and open label studies have pointed out the efficacy of LEV in generalized epilepsy. [13][14][15][16] Moreover, LEV has been shown to be effective in preventing the photoparoxysmal response in patients with photosensitive epile...

Efficacy and safety of levetiracetam in pediatric epilepsy

“…Most of the seizure types were found to be of tonic-clonic type. Preliminary evidence by Verrotti et al (2008) revealed that LEV may be effective for treating 32 adolescent patients with newly diagnosed Juvenile myoclonic epilepsy (JME). Verrotti and his colleagues found at 6-month evaluation: 15 patients were seizure free; 14 patients were responders (>50% reduction in seizures); and three patients had marginal effects (<50% reduction of seizures).…”

Levetiracetam in Childhood Epilepsy

“…[46] In 32 patients with epilepsy (20 males, 12 females) with a mean age of 13 years 3 months (SD 7 years 11 months) at seizure onset, levetiracetam was administered as the first drug. The dosage that achieved seizure control ranged from 1000 to 2500 mg day.…”

Treatment options for epileptic myoclonus and epilepsy syndromes associated with myoclonus

“…Ethosuximide can be added to control absence seizures, if these are prominent. Levetiracetam has shown efficacy in open-label and randomized, double-blind, placebo-controlled trials against GTCS and myoclonic seizures in different types of idiopathic generalized epilepsies [34,[84][85][86][87][88]. In our centre, this is the first-line medication now, given its better sideeffect profile than valproate and topiramate, and its clearly greater efficacy compared with lamotrigine.…”