Efficacy of levetiracetam for reducing rolandic discharges in comparison with carbamazepine and valproate sodium in rolandic epilepsy

Abstract

A R T I C L E I N F O Keywords:Levetiracetam (LEV) Rolandic epilepsy (RE) Electroencephalogram (EEG) Rolandic discharge (RD) Anti-epileptic drug (AED) A B S T R A C T Purpose:The main purpose of this study was to compare the efficacy of levetiracetam (LEV) with the older antiepileptic drugs (AEDs) for preventing atypical evolution in children with Rolandic epilepsy (RE). Accordingly, the present study compared the efficacy of older AEDs (carbamazepine (CBZ) and valproate sodium (VPA)) with LEV in reducing rolandic discharges (RDs) on interictal electroencephalogram (EEG) in children with RE. Methods: Patients in this heterogenous study were subdivided into CBZ, VPA and LEV groups in accordance with the initial monotherapy. The CBZ and VPA groups were studied retrospectively, but the LEV group was studied prospectively. Appearances of discharges were counted and these rates were computed. In comparison with the baseline RD frequency, EEG response to AED treatment was classified such as complete disappearance and response (≥50% reduction in RD frequency). The time taken to attain complete disappearance or response in EEG responders was assessed for each AED treatment group. Results: Responders comprised 10 (11.2%) of the 89 patients treated with CBZ, 41 (56.2%) of the 73 patients with VPA, and 25 (71.4%) of the 35 patients with LEV. Mean interval to achievement of EEG response in the CBZ, VPA, and LEV groups were 36.3, 23.1, and 14.7 months, respectively. EEG response was achieved significantly more rapidly with LEV than with CBZ (p < 0.001) or VPA (p < 0.005). Seizure control was not significantly different in all 3 investigated drugs. Conclusions: LEV seems to be superior to CBZ and VPA in its ability to suppress RDs in children with RE.

Anti-Seizure Medication Treatment of Benign Childhood Epilepsy With Centrotemporal Spikes: A Systematic Review and Meta-analysis

“…Two studies performed by Wang et al and Sun et al applied the Wechsler Intelligence Scale to explore the effect of ASMs and revealed that VPA was associated with a worse effect on cognitive improvement than OXC and LEV (Sun, 2015;Wang WX et al, 2019). Similar discrepant results of other ASMs can also be seen in different comparative studies (Kanemura et al, 2018;Kim et al, 2018;Tacke et al, 2018).…”

“…For example, Tacke et al conducted an RCT study ( Tacke, et al, 2018 ) to examine the influence of ASM treatment (STM and LEV) on EEG and revealed that treatment with both STM and LEV significantly reduced the spike-wave index, with no differences between the two treatment groups. A study ( Kanemura, et al, 2018 ) conducted by Kanemura et al reported similar results and revealed that LEV seems superior to CBZ and VPA in its ability to suppress rolandic discharges (RDs) interictally in children with BECTS. Our meta-analysis results showed that STM was related to a higher probability of EEG normalization than placebo, while there was no difference between VPA versus CBZ, OXC, and LEV versus CBZ.…”

Treatment for the Benign Childhood Epilepsy With Centrotemporal Spikes: A Monocentric Study

“…In this study, levetiracetam plus sodium valproate showed statistically significant association with reduction of SWI. In comparison with carbamazepine and sodium valproate, levetiracetam was superior in suppressing rolandic discharges, however, the effects of those three drugs in controlling seizures were the same according to one study (29). A randomized controlled trial revealed that both levetiracetam and sulthiame have beneficial effects on EEG normalization (23).…”

A comparative study on the efficacy of levetiracetam and carbamazepine in the treatment of rolandic seizures in children: An open-label randomized controlled trial

“…currently reported that levetiracetam was effective and well tolerated as monotherapy in pediatric patients with rolandic epilepsy, and it seemed to be superior to carbamazepine and valproic acid in its ability to suppress rolandic discharges in children; however, the trends of the efficacy of levetiracetam were not significantly higher. [ 15 16 17 ] Asadi-Pooya et al . reviewed the current literature and suggested that levetiracetam is probably a better choice compared with carbamazepine to be prescribed for children with rolandic epilepsy due to its better effect on cognitive problems, better tolerance, and fewer side effects in comparison with other antiepileptic drugs.…”