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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to determine the efficacy and tolerability of 1000-4000 mg/day of levetiracetam (LEV, Keppra) as add-on treatment for refractory epilepsy. This was a dose-escalation study of 29 patients with refractory epilepsy. Patients received placebo for 4 weeks (baseline) followed by levetiracetam 1000 and 2000 mg per day each for 2 weeks, and then 3000 and 4000 mg per day each for 4 weeks. Primary efficacy was assessed by seizure frequency (number/week). Tolerability was assessed by adverse events, laboratory parameters, clinical evaluations, and electrocardiogram. All the study periods were completed by 27 of the 29 patients. A substantially lower median seizure frequency was observed at all levetiracetam dosing periods (1000 mg per day, 1.0 seizures per week; 2000 mg per day, 1.5 seizures per week; 3000 mg per day, 1.0 seizures per week; 4000 mg per day, 0.75 seizures per week) compared with the placebo treatment (2.06 seizures per week). In addition, 22-33% of these patients were seizure free during treatment with levetiracetam compared with only 14% with placebo. Levetiracetam was well tolerated. The most common adverse events were somnolence and asthenia; frequency and severity increased with increasing doses of levetiracetam. Levetiracetam in doses from 1000 to 4000 mg per day is effective. Somnolence and asthenia were more frequent with the highest dose, suggesting that 4000 mg per day may be the upper limit in some patients, although individual susceptibility to somnolence was variable.
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PMID:Efficacy and tolerability of 1000-4000 mg per day of levetiracetam as add-on therapy in patients with refractory epilepsy. 1107 81

The effect of acute treatment with the new antiepileptic drug (AED) levetiracetam (Keppra) on the frequency of interictal epileptiform discharges (IEDs) was evaluated in a double-blind, placebo-controlled, crossover study with therapeutic drug monitoring and serial electroencephalographic (EEG) observations. Acute (500 mg twice daily) and chronic (individualized, 500-1000 mg twice daily) doses of levetiracetam were administered as an add-on to current AED treatment. Efficacy was tested by measuring the frequency of IEDs in EEG recordings and the number of seizures. A single acute dose of levetiracetam induced a reduction of IEDs in eight out of ten patients. During the acute phase, an insufficient number of seizures occurred for analysis. During chronic treatment over 8 weeks, seven patients showed a reduction in seizure frequency (responder rate), and one patient remained seizure free. No correlation was seen between levetiracetam levels and IED frequency. Doses of levetiracetam of up to 2000 mg/day were well tolerated, and no interactions were seen with concomitant AEDs.
Seizure 2001 Dec
PMID:Effect of levetiracetam in patients with epilepsy and interictal epileptiform discharges. 1179 61

The pharmacotherapy of seizure disorders has long relied on a few standard medications such as phenobarbital, phenytoin (Dilantin), valproate (Depakote), and others that represent the "first generation" of anticonvulsants. This article reviews the newer, "second-generation" anticonvulsants that were developed in the last decade. The addition of these second-generation agents has doubled the number of therapies available for the treatment of seizure disorders. They include felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), tiagabine (Gabitril), topiramate (Topamax), and zonisamide (Zonegran). This article describes the known side effects of the second-generation agents and reviews the adverse reactions of the first generation of anticonvulsants as a guide to potential toxicities. Reference tables are included that note usual dosages, available dosage forms, and tablet imprint. In addition, this article describes monitoring parameters and gives specific information regarding the use of these agents.
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PMID:Second generation anticonvulsant medications: their use in children. 1188 12

Levetiracetam (Keppra--UCB Pharma) is a new anti-epileptic drug, marketed in the UK since 2000. It is licensed for use as adjunctive treatment for partial seizures, with or without secondary generalisation, in people aged over 16 years. The company claims that levetiracetam is "highly effective", with a "therapeutic starting dose", "excellent tolerability", and "no known drug/drug interactions". Here, we discuss the place of levetiracetam in the treatment of patienTs with epilepsy.
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PMID:Levetiracetam--a new drug for epilepsy. 1199 65

Anticonvulsants are frequently used in the treatment of paroxysmal kinesiogenic choreoathetosis (PKC). Although they are often extremely effective in eliminating paroxysmal movements, short- and long-term side-effects may limit their use in young patients. Levetiracetam (Keppra), a novel antiepileptic drug approved for the treatment of partial seizures is well tolerated in patients with epilepsy. We report on the use of levetiracetam in the treatment of PKC. Levetiracetam was effective in eliminating paroxysmal events and should be considered as an alternative to standard antiepileptic medications in this disorder.
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PMID:Levetiracetam in the treatment of paroxysmal kinesiogenic choreoathetosis. 1211 21

This study compared levetiracetam (Keppra) with reference antiepileptic drugs (AEDs) in the rat pilocarpine model of temporal lobe epilepsy. Electroencephalogram (EEG) recordings showed that i.p. administration of valproate (300 mg/kg), phenobarbital (5 mg/kg) and clonazepam (0.5 mg/kg) all significantly delayed the appearance of the first epileptic spike discharge in hippocampus as well as synchronous epileptiform activity in hippocampus and cortex. In contrast, i.p. administration of levetiracetam (17 mg/kg) only significantly delayed the appearance of the latter. This was corroborated by findings showing that i.p. administration of levetiracetam (17 mg/kg) significantly opposed pilocarpine-induced increases in the amplitude of the orthodromic population spike in the hippocampal CA3 area of urethane-anaesthetised rats, while valproate (200 mg/kg), phenobarbital (10 mg/kg) and clonazepam (1 mg/kg) had no effect. Pre-treatment i.p. with phenobarbital (10 mg/kg) and clonazepam (0.5 mg/kg) significantly reversed seizure-induced changes in aspartate and GABA concentrations while valproate (300 mg/kg) significantly reduced aspartate concentrations further. In contrast, levetiracetam (34 mg/kg) significantly counteracted all seizure-induced alterations in amino acid concentrations. Midazolam induced significant seizure protection after microinjection into substantia nigra pars reticulata (SNR, 50 nmol), nucleus accumbens (NA, 25 nmol) and caudate putamen (CP, 25 nmol), whereas phenytoin (50 nmol) only showed significant seizure protection after injection into the latter area. Levetiracetam differed by significant seizure protection after injection into SNR (1,000 nmol) and NA (3,000 nmol). These results suggest that levetiracetam is distinct from other AEDs by its ability to selectively suppress synchronisation of neuronal spike and burst firing in hippocampus.
Seizure 2003 Mar
PMID:Electrophysiological, neurochemical and regional effects of levetiracetam in the rat pilocarpine model of temporal lobe epilepsy. 1256 32

The effect of the new antiepileptic drug (AED) levetiracetam (LEV, Keppra) on cognitive function was studied in normal and amygdala-kindled rats by using the Morris water maze test. In addition, we investigated the effect of LEV on long-term potentiation (LTP) in rat hippocampal slices. Sodium valproate (VPA) was used as comparator in all studies. Clonazepam (CZP) and carbamazepine (CBZ) were used in normal rats. The results indicated that doses of LEV known to suppress motor seizures did not alter cognitive performance. In contrast, similar doses of the classic AEDs all decreased learning performance of the rats. Likewise, VPA did alter LTP but LEV was inactive. Amygdala-kindled rats were more sensitive than normal rats to the effects of VPA. These results suggest that LEV may be devoid of negative impact on cognition in epileptic patients.
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PMID:Absence of negative impact of levetiracetam on cognitive function and memory in normal and amygdala-kindled rats. 1260 64

We identified 37 patients with a history of partial seizures, with and without secondarily generalization, who received levetiracetam (LEV) (Keppra) monotherapy. Patients began LEV either as first line therapy (n=9) or were converted to LEV monotherapy (n=28) after failing prior antiepileptic medications (AEDs). Thirty-four patients continued on LEV for at least six months; of these, 13 patients became seizure free and 15 patients had >50% reduction in their seizures. Three patients discontinued LEV because of adverse effects. LEV monotherapy can be effective and well tolerated in adults with new onset and difficult-to-control partial epilepsy. A prospective, large, double blind monotherapy study is needed to confirm this finding.
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PMID:Levetiracetam monotherapy for adults with localization-related epilepsy. 1260 70

We retrospectively reviewed the charts of all of our patients with a history of partial seizures, with and without secondarily generalisation, who received levetiracetam (LEV; Keppra) for treatment of their seizures during the years 2000-2002. Forty-five patients were identified, 13 of whom began LEV as first line therapy. Eleven patients continued on LEV for at least 6 months; six of whom became seizure free and five had >50% reduction in their seizures. The remaining two patients discontinued LEV because of adverse effects. LEV monotherapy can be effective and well tolerated in adults with new onset seizures. A prospective, large, double-blind monotherapy study for newly diagnosed patients is needed to confirm this finding.
Seizure 2003 Apr
PMID:Levetiracetam monotherapy for newly diagnosed epilepsy patients. 1265 Oct 80

NINE NEW MOLECULES: Since 1990, nine antiepileptic drugs have been launched in France: vigabatrin (Sabril), felbamate (Taloxa), gabapentin (Neurontin), lamotrigine (Lamictal), tiagabine (Gabitril), fosphenytoin (Prodilantin), topiramate (Epitomax), oxcarbazepine (Trileptal) and levetiracetam (Keppra). INDICATIONS EXTENDING: The indications for these new antiepileptic molecules, initially indicated in the case of insufficient efficacy or intolerance to first (phenobarbital, phenytoin) or second generation (valproate, carbamazepine) antiepileptics are in fact progressively extending, notably with the approval of first line monotherapy with gabapentin (partial epileptic seizures in adults), lamotrigine (partial and generalised epilepsy, and in addition in children) and oxcarbazepine (partial epilepsy). PROBLEMS OF TOLERANCE: Two molecules (vigabatrin and felbamate) had their prescription reduced because of rare but severe side effects, which had not been detected during the studies preceding marketing authorisation. The availability of these new antiepileptics has broadened and diversified but also complicated the medical management of epilepsy. Although the efficacy of the molecules has been demonstrated, particularly in certain specific indications, some products (felbamate, tiagabine, topiramate) exhibit an average efficacy/safety profile, whereas others (felbamate, lamotrigine) expose the patients to rare but potentially severe idiosyncratic effects. Moreover, some drugs with limited spectrum (vigabatrin, gabapentin, tiagabine and oxcarbazepine) may even worsen the symptoms of epilepsy. INTEREST AND LIMITS: The new antiepileptics often lead to remarkable results in cases of moderate epilepsy. However, they do not appear to change the conditions of the small percentage of patients who suffer from truly severe epilepsy. More targeted indications, notably in children, warrant specification in rigorous clinical trails that are still difficult to elaborate. All these data justify the efforts made in the development of new drugs, and the emergence of surgical and alternative approaches.
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PMID:[New epileptic treatments. Current modalities and their utilization]. 1271 20


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