Clinical experience of levetiracetam monotherapy for adults with epilepsy: 1-year follow-up study

Abstract

We identified 46 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=11) or were converted to LEV monotherapy (n=35) after failing prior antiepileptic medications (AEDs). Patients were followed up to 12 months after LEV started. The majority of these patients were able to continue on LEV and a small number of patients discontinued LEV secondary to lack of efficacy. One third of the non-seizure free group at 6 months of follow-up had worse seizure control at 12 months and two thirds had the same or better seizure control. Our 1-year follow-up data of LEV as monotherapy suggests that LEV can be effective and well tolerated in adults with either new or difficult to control epilepsy. A prospective, large, long-term double-blind study is needed to confirm this finding.

Monotherapy for partial epilepsy: focus on levetiracetam

“…Although LEV is well tolerated with a favorable pharmacokinetic profile, few works demonstrated successful conversion to monotherapy in patients with refractory epilepsy, and few studies with small number of patients demonstrate its effectiveness as a single agent in partial epilepsy (Ben-Menachem and Falter 2000; Alsaadi et al 2005; Brodie et al 2007). In a multicenter double-blind, responder selected study (Ben-Menachem and Falter 2000), it was evaluated the efficacy and tolerability of LEV monotherapy in selected patients with refractory focal epilepsy: in the LEV monotherapy group the median percent reduction in partial seizure frequency compared with baseline was 73.8% with a responder rate of 59.2%.…”

Pharmacotherapy of Epilepsy: Focus on Levetiracetam

“…39 Alsaadi and colleagues evaluated patients who had started levetiracetam either as monotherapy or had been converted to monotherapy in this single center study. 40 Forty-six patients were identified by the authors; however, only thirty-five patients were evaluated for 1 year. At 1 year, 19 (54%) patients were seizure free for at least the past six months (8 monotherapy).…”

“…Three patients discontinued levetiracetam after the first two weeks of treatment due to feeling nervous and irritable. 40 Bauer and colleagues conducted an open-label study evaluating the long-term use of levetiracetam for epilepsy. 41 Five hundred five patients enrolled in the study with 274 completing successfully.…”

“…The most frequently listed reasons for withdrawal of levetiracetam in studies include somnolence, nausea, vomiting, asthenia, headaches, dizziness, convulsions/ tremors, nervousness, irritability, depression, and increased seizures. 27,37,40,64 When overall tolerability was directly compared to controlled-release carbamazepine, a larger amount of carbamazepine subjects withdrew due to adverse effects compared to levetiracetam; 19.2% versus 14.4%, respectively. 42 Depression and insomnia was reported more often with levetiracetam whereas back pain was reported more often with carbamazepine.…”

Levetiracetam in Clinical Practice: Efficacy and Tolerability in Epilepsy

“…In two recent studies examining LEV efficacy on drug resistant patients in everyday clinical practice, 16.3% and 10% respectively achieved seizure freedom after addition of LEV therapy 4,5 . Recent studies suggest LEV efficacy also as monotherapy in new-onset partial epilepsy and idiopathic generalized epilepsy 6,7 . Because of its favorable pharmacokinetic profile, LEV is particularly suitable for special populations (such as elderly patients, patients with cognitive problems, patients with treated co-morbidities) in which traditional AEDs are often poorly tolerated because of drug-todrug interactions, negative impact on cognitive function, toxicity on liver function 8,9 .…”