Posts Tagged Keppra
Daily pyridoxine (vitamin B6) was found to be an effective treatment for the behavioral adverse effects seen with the antiepileptic drug levetiracetam, according to a poster presented at the AES Annual Meeting 2017.
Treatment with levetiracetam (Keppra; UCB) has been shown to cause non-psychotic behavioral effects (eg, aggression, anger, emotional lability, anger, depression, anxiety) in clinical studies (13% in levetiracetam-treated patients vs 6% in placebo-treated). Currently, there is a lack of data regarding the treatment of behavioral effects of levetiracetam, which represents a key cause of treatment discontinuation.
For the retrospective study, Creighton University School of Medicine researchers evaluated whether pyridoxine supplementation could benefit patients who are experiencing behavioral adverse effects due to levetiracetam. The team reviewed electronic medical records of all patients in the Creighton University Epilepsy Center Clinic (2011–2015) for those taking levetiracetam. Forty-five of the 380 total patients receiving levetiracetam (median dose 1000mg daily; highest dose 4000mg daily) were initiated on pyridoxine 100mg daily for symptom control.
The data showed 11.8% of levetiracetam-treated patients experienced behavioral side effects with agitation, insomnia, and irritability being the most commonly observed. These behavioral changes were typically seen within the first month of starting levetiracetam therapy. Nearly all of the patients who received pyridoxine (42/45; 93.3%) remained on levetiracetam therapy as they saw significant improvement in their behavioral symptoms.
“This benefit is seen across the entire range of levetiracetam dosing,” lead author Kalyan Sajja noted. Supplementation with pyridoxine 100mg daily enabled continued treatment with levetiracetam in these patients. The authors added that a large multicenter, prospective, randomized-controlled trial can further validate this clinical benefit.
Sajja K, Sankaraneni R, Galla K, Singh SP. Role of Pyridoxine (Vitamin B6) in the Treatment of Levetiracetam Induced Behavioral Effects in Epilepsy Patients. Presented at: AES annual meeting in Washington, DC. Abstract 1.308.
The dangerous drug attorneys at the Law Offices of Gregory Krasovsky can provide legal advice and representation to individuals and families considering pursuing a Keppra lawsuit. In order for a plaintiff to secure a maximum settlement in litigation of a Keppra claim, regardless of whether in an individual lawsuit or in a class action lawsuit, it is crucial that the law firm representing you have a competent and experienced team of Keppra lawyers to guide you through all of the legal hurdles as well as direct you to sufficient funding (litigation funding or legal finance) to cover pharmaceutical litigation costs. Contact a Keppra attorney today to schedule a free consultation and take your first step to obtaining compensation for losses caused by Keppra side effects.
Keppra, which is generically known as Levetiracetam, is an anticonvulsant drug used to treat epilepsy. Keppra was originally manufactured and marketed by UCB Pharmaceuticals Inc., but now it is available as a generic and is manufactured by a number of firms. Unfortunately, Keppra has a number of serious side effects that can, at times, outweigh its benefits for people who are suffering from epilepsy. Some of the most serious Keppra adverse effects include suicidal tendencies and birth defects.
There are many Levetiracetam side effects. These include, but are not limited to, the following:
- Suicidal Ideation
- Suicidal Tendencies
- Unsteady Walk
- Sore Throat
- Mood Changes
- Changes in Skin Color
- Birth Defects
A 2005 Food and Drug Administration (FDA) study of suicidal ideation in relation to epilepsy drugs has indicated that people taking those drugs, such as Keppra, are twice as likely to suffer from suicidal thoughts as are those who have not been taking these drugs.
Unlike many other drugs, such as Wellbutrin, people taking Keppra are likely to experience suicidal ideation regardless of what age group they might happen to fall into. The aforementioned study tracked almost 30,000 people, and the rick of suicide was spread fairly evenly across the population. Of the 28,000 people who had taken Keppra in this study, four of them had actually committed suicide. These unfortunate incidents serve to confirm the danger of this unsafe drug.
Although Keppra’s ability to cause birth defects is still under investigation, there is some amount of evidence that seems to confirm that Keppra is more harmful to unborn babies than was previously thought. Currently, the FDA has placed Keppra in the Category C for pregnancy, which indicates that there is little human risk. However, AdverseEvents, Inc. believes that Keppra should perhapd be in Category D, which indicates that a significant enough risk to pregnancy exists.
Keppra is similar to another prototypical nootropic drug called piracetam. Keppra is also thought to be a possible treatment for Tourette syndrome, autism, bipolar disorder, and anxiety disorder.
The attorneys at this Keppra law firm believe that drugs should not cause the same ailments that they are meant to cure. If you or your loved one has been injured as a result of taking Keppra, you might be entitled to compensation. Contact our attorneys today to schedule a free consultation.
Newer Epilepsy Drugs May Be Safer During Pregnancy
Small British study says two drugs don’t harm a child’s mental development, but popular older one does
THURSDAY, Sept. 1, 2016 (HealthDay News) — Women who take the new epilepsy drugs levetiracetam and topiramate during pregnancy don’t run the risk of harming their infant’s mental development, British researchers report.
But the commonly prescribed anti-seizure drug valproate was linked with lower IQs in children, especially when taken at higher doses, researchers say.
“The treatment of epilepsy in women who are considering a pregnancy or are pregnant involves optimizing the health of the mother as well as keeping the risk to the fetus as low as possible,” said lead researcher Rebecca Bromley, a research fellow at the Institute for Human Development at the University of Manchester.
In the study, children exposed to levetiracetam (Keppra) or topiramate (Topamax) in the womb did not differ from children not exposed to these drugs. And they had better outcomes than the children exposed to valproate (Depakote) in terms of their IQ, thinking and language skills, Bromley said.
“These data can be used by doctors and women to help them make their decisions about which medication is best for them,” she added.
For the study, Bromley and her colleagues used the U.K. Epilepsy and Pregnancy Register to identify 171 women with epilepsy who had a child between 5 and 9 years old. During their pregnancy, 42 of the women took levetiracetam, 27 took topiramate, and 47 took valproate, the researchers said.
Bromley’s team compared the women with epilepsy with 55 women who did not take epilepsy drugs during pregnancy. The children had their IQ measured and took tests on verbal and nonverbal comprehension and how fast they could process visual information.
The researchers found that children of women who took levetiracetam or topiramate did not have lower IQs or other thinking-skill problems, compared with kids of mothers who did not take these drugs, no matter what dose of these drugs were taken.
Children whose mothers took valproate, however, had the lowest IQs of the study, Bromley said. These kids scored, on average, 11 points lower on the IQ test.
Among children whose mothers took valproate, 19 percent had IQs lower than the average score of 100, compared with 6 percent among kids whose mothers did not take any epilepsy drugs during pregnancy, the researchers found.
Because the registry the researchers used does not include all women with epilepsy, the findings might not apply to all women with the conditions, Bromley noted. She also said that topiramate, one of the newer drugs, has been associated with an increased risk of birth defects, such as cleft lip and palate.
The study was funded by Epilepsy Research U.K. and the report was published online Aug. 31 in the journal Neurology.
Dr. Ian Miller is a pediatric neurologist and medical director of the comprehensive epilepsy program at Nicklaus Children’s Hospital in Miami. “This study means that we have a little bit more information for women who become pregnant while taking epilepsy medicines,” he said.
The exact risks of taking any medicine during pregnancy are very difficult to know, he added.
“As a result, many questions remain,” Miller said. “But this study gives doctors a reason to choose topiramate or levetiracetam, which did not show a measurable effect on the child’s development, rather than valproate, which did.”
Women who are on valproate because they already tried other medications and “moved on because those medications were less effective, will face some difficult decisions,” he said.
“Any woman of childbearing potential should discuss this aspect of their medical management with their doctor, especially in light of these new findings,” Miller added.
SOURCES: Rebecca Bromley, Ph.D., research fellow, Institute for Human Development, University of Manchester, England; Ian Miller, M.D., pediatric neurologist, and medical director, comprehensive epilepsy program, Nicklaus Children’s Hospital, Miami; Aug. 31, 2016, Neurology, online
I had a subdural hematoma from a rock climbing fall back in 2003. I was rescued by helicopter and taken to a trauma center where I had a craniotomy to stop the bleeding. I was told by the surgeons that I had an excellent chance of a full recovery, which proved to be true after about five months.
In January 2010, I had a grand mal seizure. After MRIs and an EEG, the seizure was thought to be a one-time event due to drinking too much and then coming home and taking some prescription sleep medication, which lowered my seizure threshold.
But a month ago, I had a tonic-clonic seizure totally by surprise. I was at a meeting and was not drinking. I had been working extremely hard and not sleeping well as a result. I was told to take 1,000 of Keppra per day which had terrible side affects. I cut back the Keppra to 250mg before bedtime and that’s all. My doctor is sending me another brand of medication to try.
Why would I have seizures seven years after the accident? And, what are the chances of staying off medication and just taking good care of myself? I have been sleeping regularly and better, quit drinking alcohol, exercising, doing meditation and yoga, and I feel great.
A Refresher: Treating Status Epilepticus in the ICU
I was working in the intensive care unit (ICU) the other night when I was called to the emergency department to see a patient who was reported to be in status epilepticus (SE). The patient had received several doses of lorazepam (Ativan®) and was loaded with intravenous levetiracetam (Keppra®). I hadn’t ever used levetiracetam for patients with SE before, so I went ahead and loaded the patient with fosphenytoin (Cerebyx®). I’d hardly call myself an expert in neurocritical care, so I figured it was time to go back and read about the management of SE in the ICU.
There’s no shortage of review articles out there, but I started with guidelines published by the Neurocritical Care Society in 2012. Levetiracetam is on the list of agents recommended for emergent, urgent, and refractory treatment of SE. All levetiracetam recommendations are class IIb/level C (more data are needed, but treatment is not unreasonable based on consensus opinion, case reports, or standard of care).
A quick look at the available references confirms that most are small case reports or observational case series. A recent review says that the practice of using levetiracetam shows promise—citing efficacy, safety, and tolerability across studies and one pilot study that compared levetiracetam to lorazepam. They also noted that the Neurocritical Care Society guidelines list no serious adverse effects and minimal drug interactions. Perhaps levetiracetam is the ideal drug to use in the elderly and in the ICU.
To be clear, I’ll still be using lorazepam as my first line based on the results from the Veterans Affairs Status Epilepticus Cooperative Study Group. It’s absolutely the best designed study on SE that we have. For urgent control, levetiracetam sure looks like a reasonable option when compared with fosphenytoin, which often causes hypotension.
Cost: A Reasonable Consideration
Of course, cost must be considered, and while I was unable to find a cost-efficacy analysis specific to SE treatment, studies looking at levetiracetam vs phenytoin for prophylaxis after traumatic brain injury clearly favored phenytoin.[4,5]
It’s not clear that these data can be readily generalized to SE treatment. In summary, for patients who are elderly, hemodynamically unstable, or on multiple medications, I’ll be using levetiracetam at the doses recommended in the recent guidelines.
[WEB SITE] Keppra (Levetiracetam) Drug Information: Description, User Reviews, Drug Side Effects, Interactions
KEPPRA is an antiepileptic drug available as 250 mg (blue), 500 mg (yellow), 750 mg (orange), and 1000 mg (white) tablets and as a clear, colorless, grape-flavored liquid (100 mg/mL) for oral administration…
…Fetal exposure to anti-epileptic drugs (AEDs) appears to carry risks beyond those congenital defects currently listed on the products’ labels, a researcher said here…
…Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence…
One of the problems that can occur after a traumatic brain injury (TBI) is seizures. Although most people who have a brain injury will never have a seizure, it is good to understand what a seizure is and what to do if you have one. Most seizures happen in the first several days or weeks after a brain injury. Some may occur months or years after the injury. About 70-80% of people who have seizures are helped by medications and can return to most activities. Rarely, seizures can make you much worse or even cause death.
What are seizures?
Seizures happen in 1 of every 10 people who have a TBI that required hospitalization. The seizure usually happens where there is a scar in the brain as a consequence of the injury.
During a seizure there is a sudden abnormal electrical disturbance in the brain that results in one or more of the following symptoms:
- Strange movement of your head, body, arms, legs, or eyes, such as stiffening or shaking.
- Unresponsiveness and staring.
- Chewing, lip smacking, or fumbling movements.
- Strange smell, sound, feeling, taste, or visual images.
- Sudden tiredness or dizziness.
- Not being able to speak or understand others.
Symptoms of a seizure happen suddenly, and you are unable to control them. Seizures usually last only a few seconds or minutes, but sometimes continue for 5 to 10 minutes. You may have a bladder or bowel accident or bite your tongue or the inside of your mouth during a seizure. After the seizure, you may be drowsy, weak, confused or have a hard time talking to or understanding others. After a severe seizure, one that lasts longer than 2 minutes, it may be harder for you to stand, walk or take care of yourself for a few days or even longer.
Conditions that could increase the risk of having a seizure include:
- High fever.
- Loss of sleep and extreme fatigue.
- Drug and alcohol use.
- Chemical changes in the body such as low sodium or magnesium, or high calcium.
Seizures and TBI
- Early post-traumatic seizures: A seizure in the first week after a brain injury is called an early post-traumatic seizure. About 25% of people who have an early post-traumatic seizure will have another seizure months or years later.
- Late post-traumatic seizures: A seizure more than seven days after a brain injury is called a late post-traumatic seizure. About 80% of people who have a late post-traumatic seizure will have another seizure (epilepsy).
- Epilepsy: Having more than one seizure is called epilepsy. More than half the people with epilepsy will have this problem for their whole lives.
The cause of your brain injury can help doctors figure out how likely you are to have seizures.
- 65% of people with brain injuries caused by bullet wounds have seizures.
- 20% of people with ‘closed head injuries’ that cause bleeding between the brain and the skull experience seizures. A ‘closed head injury’ means the skull and brain contents were not penetrated in the injury.
- Over 35% of people who need 2 or more brain surgeries after a brain injury experience late post-traumatic seizures.
Medications to treat seizures
Medications that are used to control seizures are called antiepileptic drugs (AEDs). These drugs may be used for other problems, such as chronic pain, restlessness, or mood instability. You and your doctor will decide on which drug to use based on your type of seizures, your age, how healthy you are, and if you get any side effects from the medications. Side effects of AEDs usually improve after you’ve been taking the medication for 3-5 days.
Some common side effects of AEDs are:
- Sleepiness or fatigue.
- Worsening of balance.
- Lightheadedness or dizziness.
- Double vision.
Blood tests may be needed to make sure you are getting enough of the medication and to make sure the drug isn’t causing other problems. Although these drugs rarely cause birth defects in newborns, tell your doctor if you are pregnant or may become pregnant.
Sometimes your doctor will prescribe two or more of these medications to stop your seizures. Some common AEDs are:
- Carbamazepine (also known as Tegretol).
- Lamotrigine (also known as Lamictal).
- Levitiracetam (also known as Keppra).
- Gabapentin (also known as Neurontin).
- Oxcarbazepine (also known as Trileptal).
- Phenytoin/ fosphenytoin (also known as Dilantin).
- Pregabalain (also known as Lyrica).
- Topiramate (also known as Topamax).
- Valproic acid or valproate (also known as Depakene or Depakote).
- Zonisamide (also known as Zonegran).
What if the medications do not work?
If your seizures continue even after trying medications, your doctor may refer you to a comprehensive Epilepsy Center for more tests and to be seen by special seizure doctors called epileptologists or neurologists specializing in epilepsy. At the comprehensive Epilepsy Center the doctors may do brain wave tests and take a video of you during one of your seizures to help figure out what is causing the problems. This may help your doctor decide what drug will work best, and to see if other types of treatment will help with the problems you are having.
In most states, if you have had a seizure you cannot drive and you must notify the department of motor vehicles (DMV). Usually you won’t be able to return to driving for a period of time, or until your seizures have been completely stopped. Laws vary from state to state regarding how long after a seizure you must not drive.
Other things you should do to stay safe if your seizures have not stopped:
- Always have someone with you if you are in water (pool, lake, ocean, bath tub).
- Don’t climb on ladders, trees, roofs or other tall objects.
- Let people you eat with know what to do in case you have a seizure and start choking.
What your caregiver should do if you are having a seizure
Family members or caregivers should watch closely to see what happens during a seizure so they can explain it to medical professionals. They should make a diary describing the date, time of day, length of time, and description of each seizure. Your doctor will need this information about your seizures and the drugs you are taking to control them.
The majority of seizures are short and do not result in significant injuries. However, it is important for your caregivers to know what to do to keep you from hurting yourself.
What to do for someone having a seizure:
- Loosen tight clothing, especially around the neck.
- Make sure the person does not fall. Hold the person steady if he or she is in a chair, couch or bed. If the person is standing, get him or her to the ground safely.
- Turn the person and his or her head to the side so that anything in the mouth, even spit, does not block the throat.
- It can be dangerous to put anything in the mouth as you can get bitten.
- If you know CPR, check the heart beat in the neck. Start CPR if there is no pulse. Call 911.
- Listen for breathing at the mouth and extend the neck if breathing is difficult. If there is no breathing, start CPR by sealing your lips over the person’s mouth and breathing 2 quick breaths. Continue breathing every 5 seconds unless the person starts breathing without help. Call 911.
- If this is the first seizure after TBI, call the person’s doctor for advice.
- If the seizure does not stop after 3 minutes, call 911.
- If the seizure stops within 3 minutes, call the person’s doctor.
- If the person does not return to normal within 20 minutes after the seizure, call 911.
For More Information
The Epilepsy Foundation of America
Brain Injury Association of America
- Diaz-Arrastia R, Agostini MA, Frol AB et al, Neurophysiologic and neuradiologic features of intractable epilepsy after traumatic brain injury in adults. Arch Neurol 2000; 57:1611-6.
- Englander J, Bushnik T, Duong TT et al, Analyzing risk factors for late posttraumtic seizures: a prospective, mulitcenter investigation. Arch Phys Med Rehabil 2003; 84: 365-373.
- Yablon SA, Dostrow VG. Post-traumatic seizures and epilepsy in Zasler ND, Katz DI, Zafonte RD, Brain Injury Medicine: Priciples and Practice. Demos, New York, 2007.
- Brain Trauma Foundation and American Association of Neurological Surgeons: Management and prognosis of severe traumatic brain injury 2000; pp 159-165.
This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.
Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model System directors.
Continue –> Seizures and Traumatic Brain Injury.
…A new study by researchers at The University of Texas Health Science Center at San Antonio that reviewed the medical records of Afghanistan and Iraq war veterans who sustained traumatic brain injuries (TBIs), has revealed that subjects with mild TBIs (85 percent of veterans with such injuries) are approximately 28 percent more likely to develop epilepsy than individuals without TBIs…