Open label, long-term, pragmatic study on levetiracetam in the treatment of juvenile myoclonic epilepsy

Specchio, Luigi Maria; Gambardella, Antonio; Giallonardo, Anna Teresa; Michelucci, Roberto; Specchio, Nicola; Boero, Giovanni; Neve, Angela La

doi:10.1016/j.eplepsyres.2006.05.013

Cited by 65 publications

(49 citation statements)

References 22 publications

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“…13,26,27 In particular, Krauss et al 27 treated 26 patients with JME who had not responded to other AEDs and they found 88.4% responder rates to LEV therapy. More recently, Specchio et al 21 reported the results of LEV as first line treatment in 10 of their patients. In our study, with this additional case series, we expanded this experience of LEV in JME as the first drug.…”

Section: Discussionmentioning

confidence: 99%

“…20 A few case reports and small case group studies have demonstrated a good effect of LEV in patients with JME unresponsive to conventional AEDs (valproic acid, lamotrigine) with more than 50% of patients becoming seizure free. A more recent open label study 21 suggests that LEV may be effective and well tolerated in resistant cases of JME and it can be considered a reasonable alternative to valproic acid in newly diagnosed patients.In this study, we aimed to evaluate the efficacy and tolerability of LEV as 'de novo' (mono) therapy in patients with JME. …”

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confidence: 99%

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

Verrotti

Cerminara

Coppola

et al. 2007

Develop Med Child Neuro

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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...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Verrotti

Cerminara

Coppola

et al. 2007

Develop Med Child Neuro

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“…Although there is no current FDA indication for its use as a monotherapy agent for JME, there is published data that support its use as a monotherapy agent for this indication in both adults and adolescents. 30,[32][33][34][35][36] A few openlabel observational studies have been conducted on patients with JME (n = 32; n = 48) 32,35 and with various generalized epilepsies characterized by myoclonic seizures (n = 35). 30 Patients received levetiracetam in doses of 1000-3000 mg daily as either monotherapy or add-on therapy.…”

Section: Use For Monotherapy In Adultsmentioning

confidence: 99%

Pharmacotherapy of Epilepsy: Focus on Levetiracetam

Adams

Chung

Eiland

2009

Clinical Medicine. Therapeutics

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Abstract:Levetiracetam is a second-generation antiepileptic drug which first came to the United States market in 1999. It has a mechanism of action that is not well elucidated. However, it is a very favorable antiepileptic drug due to its reliable pharmacokinetics, minimal drug interactions, seizure efficacy and good tolerability. It is an agent that has established efficacy as an adjunct therapy agent for partial and refractory seizures. As a monotherapy agent, levetiracetam also appears to be an attractive agent with observed efficacy and tolerability. Since levetiracetam has recently become available intravenously, it is also being reviewed as an agent for acute status epilepticus. In pediatrics, levetiracetam is widely used with efficacy seen in small clinical trials for a variety of seizure types. Levetiracetam is well tolerated: the most common adverse effect being somnolence and behavioral effects. Overall, levetiracetam is a notable antiepileptic drug that has added significantly to the current antiepileptic armamentarium.

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“…According to the researches, in 41-88% of patients seizures were completely controlled by taking sodium valproate (3). 15% of JME patients are resistant to treatment with sodium valproate, and some patients cannot tolerate the complication of this drug such as, hair loss, weight gain, tremor and menstrual disorders (4).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Levetiracetam With Sodium Valproate in Controlling Seizure in Patients Suffering From Juvenile Myoclonic Epilepsy

Kashipazha

Nejad

Sadr

et al. 2014

Jentashapir J Health Res

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Background: Juvenile myoclonic epilepsy is the most common type of generalized idiopathic epilepsy. Sodium valproate is the first line of medications, but has many complications and 15% of patients are resistant to this medicine. This is a lifelong disease and in case of stopping the medication, relapsing of seizures is seen in more than 80% of cases. Objectives: Analysis the effectiveness of these two drugs on controlling patients seizures by comparing them in mono therapy treatment of JME and to represent levetiracetam as a replacement of sodium valproate for first line medication of JME. Patients and Methods:In this study we compared the effectiveness of sodium valproate and levetiracetam for 66 patients having juvenile myoclonic epilepsy and followed them for 6 months. Results: Comparison of mean generalized tonic colonic attacks in two groups with didn't show meaningful differences (P = 0.95) , also, by comparing the mean of myoclonus attacks in patients of two groups before starting study, no meaningful difference was gained (P = 0.71). Conclusions: It became clear at the end of the study that the effectiveness of two drugs were the same and they didn't have any meaningful difference. According to the result gained from this study, levetiracetam is a proper alternative treatment instead of sodium valproate which has appropriate effectiveness along with lower complications.

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Open label, long-term, pragmatic study on levetiracetam in the treatment of juvenile myoclonic epilepsy

Cited by 65 publications

References 22 publications

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

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

Pharmacotherapy of Epilepsy: Focus on Levetiracetam

Comparison of Levetiracetam With Sodium Valproate in Controlling Seizure in Patients Suffering From Juvenile Myoclonic Epilepsy

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