Levetiracetam May Be More Effective for Late-Onset Partial Epilepsy

Bazil, Carl W.; Rose, Andrew; Resor, Stanley R.; Yapicular, Bülent; Hirsch, Lawrence J.

doi:10.1001/archneur.59.12.1905

Cited by 12 publications

(6 citation statements)

References 17 publications

(6 reference statements)

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“…76.9% were responders and 40% were seizure free during the 16 weeks of the study. Another study found a better response to LEV in late-onset epilepsy (Bazil et al 2002). …”

Section: Levetiracetammentioning

confidence: 95%

“…However, one study reported that patients with temporal lobe epilepsy were more likely to be improved than patients with frontal lobe epilepsy (Bazil et al 2002). In another study, patients who had failed epilepsy surgery were much more likely to respond to LEV than patients who had never been operated: 76.1% were responders and 47.6% became seizure free compared with 34.3% responder rate and 14.7% seizure free rate in patients who never had epilepsy surgery (Motamedi et al 2003).…”

Section: Levetiracetammentioning

confidence: 99%

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Levetiracetam in the treatment of epilepsy

Abou‐Khalil

2008

NDT

198

136

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Epilepsy is a common chronic disorder that requires long-term antiepileptic drug therapy. Approximately one half of patients fail the initial antiepileptic drug and about 35% are refractory to medical therapy, highlighting the continued need for more effective and better tolerated drugs. Levetiracetam is an antiepileptic drug marketed since 2000. Its novel mechanism of action is modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A in the brain. Its pharmacokinetic advantages include rapid and almost complete absorption, minimal insignifi cant binding to plasma protein, absence of enzyme induction, absence of interactions with other drugs, and partial metabolism outside the liver. The availability of an intravenous preparation is yet another advantage. It has been demonstrated effective as adjunctive therapy for refractory partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy. In addition, it was found equivalent to controlled release carbamazepine as fi rst-line therapy for partial-onset seizures, both in effi cacy and tolerability. Its main adverse effects in randomized adjunctive trials in adults have been somnolence, asthenia, infection, and dizziness. In children, the behavioral adverse effects of hostility and nervousness were also noted. Levetiracetam is an important addition to the treatment of epilepsy.

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“…76.9% were responders and 40% were seizure free during the 16 weeks of the study. Another study found a better response to LEV in late-onset epilepsy (Bazil et al 2002). …”

Section: Levetiracetammentioning

confidence: 95%

Section: Levetiracetammentioning

confidence: 99%

Levetiracetam in the treatment of epilepsy

Abou‐Khalil

2008

NDT

198

136

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“…Increased of seizure activity and modification of seizures patterns have been reported with other drugs, including the GABAergic drugs vigabatrin [23] and tiagabine [24] and as well as drugs that are not GABAergic such as levetiracetam [25]. Gabapentin, a drug pharmacologically related to pregabalin, has been reported to induce life-threatening myoclonic status in a patient with benign adult familial myoclonic epilepsy [26].…”

Section: Discussionmentioning

confidence: 99%

Paradoxical worsening of seizure activity with pregabalin in an adult with isodicentric 15 (IDIC-15) syndrome involving duplications of the GABRB3, GABRA5 and GABRG3 genes

et al. 2013

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BackgroundIsodicentric 15 syndrome (IDIC-15) is due to partial duplications of chromosome 15 that may includes the q11–13 region that includes genes encoding the α5 (GABRA5) and β3 - γ3 (GABRB3) receptor subunits. The disease causes intellectual and physical developmental delay, seizures, intellectual disability and behavioral disorders that may be related to abnormal GABA receptor function and morphology. Seizures are often severe and may be refractory to treatment. There are however no specific guidelines for the treatment of the seizures and it is unknown whether drugs that affect the GABAergic system have a different effect in IDIC-15 seizures.Case presentationWe report the case of an adult individual with IDIC-15 whose complex-partial seizures worsened dramatically after the introduction of pregabalin, with increased seizure frequency, frequent generalization, and appearance of new seizure pattern. Her cognitive function and verbal skills also worsened during treatment with pregabalin. Her seizures and cognitive skills quickly improved after pregabalin was discontinued and treatment with lacosamide started.DiscussionAs her genetic testing confirmed that her region of duplication included GABA receptor encoding genes, it is plausible that the worsening of seizures were due to induction of an abnormal GABAergic response to pregabalin.ConclusionAs her genetic testing confirmed that her region of duplication included GABA receptor encoding genes, it is plausible that the worsening of seizures were due to induction of an abnormal GABAergic response to pregabalin.This case may help define proper therapeutic strategies for the treatment of IDIC-15 associated seizures.

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“…Caudal involvement of basal ganglia and temporal or parietal involvement within the cortex predict seizure 16 19 . Another study done by Bazil CW et al (2002) found a better response to LEV in late-onset epilepsy 20 . Phenytoin was taken by 50% patients at the time of registration and by 28 (42.42%) patients at the time of last follow up.…”

Section: Introductionmentioning

confidence: 90%

Clinical profile and outcome in elderly patients with epilepsy in a neurology tertiary care centre in eastern India

Patel¹

2018

jmscr

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Background: Epileptic seizures (ESs) are common neurological problem in the elderly. The underlying etiology and treatment of ESs is different in elderly due to underlying comorbidities and physiological changes with aging. Precise data on this topic are not readily available from developing countries. Aims: To study the clinical presentation, EEG and Neuroimaging correlation and response to drug treatment in elderly with ESs. Setting and Design: longitudinal descriptive study. Material and Methods: The patients were selected who had ESs first time after 60 years of age, were interviewed, examined, investigated and follow up for 3 months to see the response of drug treatment. Data were recorded on pre-set proforma. Statistical analysis: Used simple percentage and proportion to analysed the data. Results: There were 66 patients (38 male). Mean age was 62.33 year. ESs was partial with or without secondary generalization in 62.12% of cases. Symptomatic localization related epilepsy (LRE) was most common syndrome (66.67 %). MRI suggestive of stroke as a most identifying etiology in 43.93% of patients. Ratio of patients on monotheraphy and polytheraphy was 2.3:1. At the time of last follow up percentage of patients in Engel's score 0-4 category were increased from 4.54% to 54.54%. Conclusion: LREs were the most common type of ESs (76%) with stroke were most common identifying lesions on MRI (43.93%). Most of the patients were on monotherapy (69.7%). Significant reduction in ESs frequency was seen at the time of last follow up.

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Levetiracetam May Be More Effective for Late-Onset Partial Epilepsy

Cited by 12 publications

References 17 publications

Levetiracetam in the treatment of epilepsy

Levetiracetam in the treatment of epilepsy

Paradoxical worsening of seizure activity with pregabalin in an adult with isodicentric 15 (IDIC-15) syndrome involving duplications of the GABRB3, GABRA5 and GABRG3 genes

Clinical profile and outcome in elderly patients with epilepsy in a neurology tertiary care centre in eastern India

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