Levetiracetam Treatment-Associated Acute Rhabdomyolysis in an Adolescent

Aslan, Nagehan; Yıldızdaş, Dinçer; Huseyınlı, Behruz; Horoz, Özden Özgür; Mert, Gülen Gül; Ekinci, Faruk; Ozcanyuz, Duygu G

doi:10.1055/s-0039-1700951

Cited by 4 publications

(5 citation statements)

References 11 publications

(12 reference statements)

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“…SV2A targeted by levetiracetam may result in rhabdomyolysis. Upon review of available case studies, there is a correlation between discontinuation of levetiracetam and down-trending creatine kinase (Akiyama et al, 2014;Aslan et al, 2020;Incecik et al, 2016;Isaacson et al, 2014;Kubota et al, 2017;Di Lorenzo & Li, 2017;Moinuddin, 2020;Ramon et al, 2016;Rastogi et al, 2018;Rota et al, down-trending creatine kinase within 24-48 hours of discontinuing levetiracetam similar to clinical evidence reported in this case.…”

Section: Discussionsupporting

confidence: 79%

“…At the time of this submission, a total of 14 published levetiracetam-related rhabdomyolysis reports were available for review (Akiyama et al, 2014;Aslan et al, 2020;Incecik et al, 2016;Isaacson et al, 2014;Kubota et al, 2017;Di Lorenzo & Li, 2017;Moinuddin, 2020;Ramon et al, 2016;Rastogi et al, 2018;Rota et al, 2018;Shahbaz et al, 2017;Singh et al, 2014;Sohn et al, 2017;Thomas et al, 2019). No confirmatory studies are able to prove definitively the mechanism behind levetiracetam-induced rhabdomyolysis, a study by Chakkalakal et al suggests the SV2A protein is localized on certain types of muscle fibre (Chakkalakal et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Notably, patients in two of the three pediatric cases reviewed were already being treated with levetiracetam (Aslan et al, 2020;Incecik et al, 2016). These patients who were already receiving levetiracetam developed rhabdomyolysis after dose escalation of levetiracetam during admission.…”

Section: Discussionmentioning

confidence: 99%

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Levetiracetam induced rhabdomyolysis

2021

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Thirty-three-year-old Caucasian male underwent initiation of levetiracetam following witnessed generalized seizure activity at the same time presenting with a right MCA territory ischemic stroke. He then developed elevated CPK and myalgias are highly suspicious for rhabdomyolysis following levetiracetam. Subsequent improvement noted following complete cessation of medication. At follow-up patient reported complete resolution of hemiparesis and myalgias and no new neurological deficits while tolerating valproic acid. This case exemplifies potential rare adverse effect of levetiracetam. Levetiracetam is an antiepileptic medication effective for both generalized and focal types of epilepsy by affecting a broad spectrum of neurotransmitter release via calcium channels GABA receptors and synaptic vessel protein 2A (SV2A). Typical adverse effects include mild dizziness, headache, nausea, somnolence and sometimes hostility. This case provides further evidence of a rare and potentially life-threatening adverse effect of rhabdomyolysis. Further study is needed to possibly detect the exact mechanism resulting in this rare and dangerous adverse effect.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Levetiracetam induced rhabdomyolysis

2021

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“…We identified 26 case reports of rhabdomyolysis induced by newer-generation ASMs, with 26 patients included (10 males and 16 females) ( Kaufman and Choy, 2012 ; Gunathilake et al, 2013 ; Akiyama et al, 2014 ; Isaacson et al, 2014 ; Spengler et al, 2014 ; Incecik et al, 2016 ; Karaoulanis et al, 2016 ; Kato et al, 2016 ; Ramon et al, 2016 ; Singh et al, 2016 ; Choi et al, 2017 ; Coupal et al, 2017 ; Di Lorenzo and Li, 2017 ; Kubota et al, 2017 ; Shahbaz et al, 2017 ; Matsudaira et al, 2018 ; Mena-Martin et al, 2018 ; Rastogi et al, 2018 ; Rota et al, 2018 ; Qiu et al, 2019 ; Thomas et al, 2019 ; Aslan et al, 2020 ; Ghosh et al, 2020 ; Moinuddin, 2020 ; Alshehabi et al, 2022 ; Boucher et al, 2022 ) ( Table 3 ). All the studies were published in English and originated from the following regions: 10 cases from South America, 10 cases from Asia, 5 cases from Europe and 1 case from Oceania.…”

Section: Resultsmentioning

confidence: 99%

Rhabdomyolysis associated with newer-generation anti-seizure medications (ASMs): a real-world retrospective and pharmacovigilance study

Deng,

Wang,

2023

Front. Pharmacol.

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Objective: Rhabdomyolysis is a potentially fatal adverse reaction mostly triggered by certain medications. Few real-world studies have shown a clear association between newer-generation anti-seizure medications (ASMs) and rhabdomyolysis. We sought to quantify the risk and evaluate the clinical features and management of rhabdomyolysis associated with newer-generation ASMs.Methods: Data were retrieved from the US FDA Adverse Event Reporting System database (FAERS) from 2018 to 2022 on newer-generation ASMs to identify rhabdomyolysis events, and disproportionality analyses were conducted by estimating the reporting odds ratios (RORs) and corresponding 95% confidence intervals (CIs). Furthermore, case reports from 2012 to 31 December 2022 on newer-generation ASMs-induced rhabdomyolysis were retrieved for retrospective analysis.Results: A total of 1,130 rhabdomyolysis reports from the FAERS database were considered. Levetiracetam had the greatest proportion and the highest positive signal values of rhabdomyolysis. The RORs (95% CIs) for newer-generation ASMs were, in descending order, levetiracetam 8.01 (7.26–8.84), lamotrigine 3.78 (3.25–4.40), oxcarbazepine 3.47 (2.53–4.75), pregabalin 2.75 (2.43–3.12), lacosamide 1.85 (1.29–2.65), topiramate 1.64 (1.25–2.15), and gabapentin 1.32 (1.13–1.55). Twenty-six case reports showed evidence of rhabdomyolysis, and levetiracetam (65.4%) was the most frequently reported agent. The median age was 32 years; typical initial symptoms included muscle weakness (34.8%), myalgia (34.8%), backache (17.4%), fatigue (13.0%) and leg pain (8.7%). The median time to onset of rhabdomyolysis was 2 days. All cases had elevated creatine phosphokinase (CPK), and some cases were accompanied by elevated creatinine (57.1%) and myoglobinuria (53.8%). Cessation of ASMs could lead to complete clinical remission. The median time for creatine phosphokinase (CPK) normalization was 8 days.Conclusion: This study identified 7 newer-generation ASMs with significant rhabdomyolysis reporting associations. Prescribers should be more aware of this risk and teach patients to recognize rhabdomyolysis signs/symptoms early.

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“…Fever and serious infection were also important triggers which caused severe acute myolysis with a CK level > 50.000U/L. Up to date, fourteen patients with LEV-induced rhabdomyolysis were reported and most of them were observed in young and adolescent patients in the literature (5)(6)(7)(8)(9)(10). In a recent review analyzing 13 patients, all the patients had elevation in CK level…”

Section: Discussionmentioning

confidence: 99%

İki Yaşındaki Kız Çocuğunda Levetirasetama Bağlı Akut Rabdomiyoliz

ÖZAYDIN>¹,

Ateş

2022

Türkiye Çocuk Hast Derg

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Levetiracetam is one of the safest drugs which is used for the treatment of focal and generalized seizures during childhood. Until now, few patients have been reported with the diagnosis of acute rhabdomyolysis due to levetiracetam and our case is the youngest patient in the literature. Two-year old girl followed with atypical Rett syndrome (CDKL 5 deficiency) was admitted to our hospital with pneumonia and respiratory insufficiency. She was receiving intravenous antibiotics and levetiracetam therapy. During follow-up, the increase of creatine kinase levels continued, intravenous hydration and alkalinization was added on therapy. As we could not find any etiology explaining the raising creatine kinase levels in our patient, levetiracetam was thought to be the cause of rhabdomyolysis and withdrawn. After discontinuation of levetiracetam, creatine kinase levels began to decline within 24 h and returned to normal levels in one week. Levetiracetam-induced rhabdomyolysis is quite rare but is a life-threatening condition and should be kept in mind especially during childhood. The creatine kinase levels and renal function tests of all patients should be followed in the first week of levetiracetam therapy. Early diagnosis and supportive therapy is very important in order to prevent acute kidney injury. CDKL 5 deficiency can be a protective factor which might prevent acute kidney injury in our patient but more research is needed about this topic.

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Levetiracetam Treatment-Associated Acute Rhabdomyolysis in an Adolescent

Cited by 4 publications

References 11 publications

Levetiracetam induced rhabdomyolysis

Levetiracetam induced rhabdomyolysis

Rhabdomyolysis associated with newer-generation anti-seizure medications (ASMs): a real-world retrospective and pharmacovigilance study

İki Yaşındaki Kız Çocuğunda Levetirasetama Bağlı Akut Rabdomiyoliz

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