Posts Tagged Levetiracetam
[Poster] Effectiveness of Phenytoin and Levetiracetam for Seizure Prophylaxis Among a Traumatic Brain Injury Population: A Systematic Review
To examine the effectiveness of levetiracetam and phenytoin for seizure prophylaxis following brain injury.
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
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.
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.
While strong scientific evidence for early seizure prevention in TBI is available for phenytoin (PHT), other antiepileptic medications, eg, levetiracetam (LEV), are also being utilized in clinical settings. The use of PHT has its drawbacks, including cognitive side effects and effects on function recovery. Rates of recovery after TBI are expected to plateau after a certain period of time. Nevertheless, some patients continue to improve while others deteriorate without any clear contributing factors.
Thus, one must ask, ‘Are there any actions that can be taken to decrease the chance of post-traumatic seizures and epilepsy while minimizing potential short- and long-term effects of anticonvulsants?’ While the answer is ‘probably,’ more evidence is needed to replace PHT with LEV on a permanent basis. Some have proposed studies to address this issue, while others look toward different options, including other anticonvulsants (eg, perampanel or other AMPA antagonists), or less established treatments (eg, ketamine). In this review, we focus on a comparison of the use of PHT versus LEV in the acute TBI setting and summarize the clinical aspects of seizure prevention in humans with appropriate, but general, references to the animal literature.
[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?
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…