Background: Levetiracetam, a novel antiepileptic drug, has shown antidyskinetic effects in experimental animal models of Parkinson's disease (PD). The tolerability and efficacy of levetiracetam in reducing the levodopa-induced dyskinesia (LID) in PD patients have not been established. Therefore, this study aims to synthesize evidence from published prospective clinical trials about the efficacy of levetiracetam for the management of LID in PD patients. Methods: We followed the PRISMA statement guidelines during the preparation of this systematic review. A computer literature search of PubMed, EBSCO, Scopus, MEDLINE, and the web of science was carried out. We selected prospective clinical trials assessing the anti-dyskinetic efficacy of levetiracetam for treating LID in patients with PD. The Abnormal Involuntary Movement Scale (AIMS), Clinical Global Impression Score (GCI), UPDRS III, and UPDRS IV were considered as the primary outcome measures; their data were extracted and reviewed. Results: Our review included seven clinical trials with a total of 150 patients. Of them, three studies were randomized controlled trials, and the remaining were open-label single arm trials. Four studies reported poor tolerability of the levetiracetam with mild anti-dyskinetic effects. Levetiracetam slightly improved the UPDRS-IV and AIMS scores with small effect size. In the remaining three studies, levetiracetam failed to exhibit any anti-dyskinetic effects. Conclusion: Current evidence does not support the efficacy of the levetiracetam for treating LID in PD patients, however, due to the limited number of published randomized control trials (RCTs), further RCTs are required.

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Background: Cancer is considered as the leading cause of death in the majority of countries all over the world. Doxorubicin belongs to anthracycline group and is widely used in cancer treatment, but cardiotoxicity is one of its serious adverse effects. Metformin, a wellknown anti-diabetic drug, has cardioprotective effects and thought to protect against doxorubicin-induced cardiotoxicity. Objective: to reveal the histological and biochemical alterations in the myocardium of rats treated with doxorubicin, and to explore the impact of metformin co-treatment. Material and methods: The study was done at the Animal House, Faculty of Pharmacy, Al-Azhar University between July and September 2020. Sixty adult male albino rats were used (equally divided into 5 groups); group I: given 1ml normal saline orally every day, and also injected intraperitoneally by 1ml saline every other day for 12 days; group II: given 250 mg/kg/day of metformin orally for 12 days; group III: given 3 mg/kg of doxorubicin intraperitoneally every other day for 12 days; group IV: given 250 mg/kg/day of metformin orally and 3 mg/kg of doxorubicin intraperitoneally every other day for 12 days; group V: given 3 mg/kg of doxorubicin intraperitoneally every other day for 12 days, then left 2 months for observation from the last dose. Then, the animals were anesthetized and tissues of heart were proceeded and microscopically examined. Also, blood samples were taken for biochemical investigation. Results: In doxorubicin group, there were severe histological changes and biochemical results showed highly elevated cardiac enzymes. These results were significantly improved in metformin co-treatment and minimally improved in withdrawal group. Conclusion:This study revealed that metformin might have a protective effect against doxorubicin-induced cardiotoxicity.