Febrile seizure recurrence reduced by intermittent oral levetiracetam

Abstract

ObjectiveFebrile seizure (FS) is the most common form of childhood seizure disorders. FS is perhaps one of the most frequent causes of admittance to pediatric emergency wards worldwide. We aimed to identify a new, safe, and effective therapy for preventing FS recurrence.MethodsA total of 115 children with a history of two or more episodes of FS were randomly assigned to levetiracetam (LEV) and control (LEV/control ratio = 2:1) groups. At the onset of fever, LEV group was orally administered with a dose of 15–30 mg/kg per day twice daily for 1 week. Thereafter, the dosage was gradually reduced until totally discontinued in the second week. The primary efficacy variable was seizure frequency associated with febrile events and FS recurrence rate (RR) during 48-week follow-up. The second outcome was the cost effectiveness of the two groups.ResultsThe intention-to-treat analysis showed that 78 children in LEV group experienced 148 febrile episodes. Among these 78 children, 11 experienced 15 FS recurrences. In control group, 37 children experienced 64 febrile episodes; among these 37 children, 19 experienced 32 FS recurrences. A significant difference was observed between two groups in FS RR and FS recurrence/fever episode. The cost of LEV group for the prevention of FS recurrence is lower than control group. During 48-week follow-up period, one patient in LEV group exhibited severe drowsiness. No other side effects were observed in the same patient and in other children.InterpretationIntermittent oral LEV can effectively prevent FS recurrence and reduce wastage of medical resources.

Clinical characteristics and electroencephalogram analysis of levetiracetam in the treatment of children with febrile seizure recurrence

“…The present findings demonstrated that ~51% of the children had undergone FS recurrences within 12 months from their first FS. These findings correlate with the data collected in previous reports ( 17 , 21 , 22 ). In our study, it was demonstrated that intermittent oral LEV effectively prevented FS recurrence in the LEV group (15.6%; 7/45) as compared with the control group (51.0%; 26/51).…”

“…In several animal models, LEV has been shown to be a highly effective antiepileptic drug against partial and generalized seizures ( 26 , 27 ). A randomized clinical trial by Hu et al ( 17 ) demonstrated a significant reduction in FS recurrence with intermittent oral LEV. In the chronic phase of acute encephalitis with refractory, repetitive partial seizures, administration of LEV (750–1,500 mg/kg) has been shown to reduce seizure frequency by >75% for 5 to 18 months ( 28 ).…”

“…Levetiracetam (LEV) is a novel AED that is reported to have far less potential side effects in the treatment of brain injury ( 16 ). Evidence has shown that LEV can effectively prevent FS recurrence ( 17 ). A previous systematic review and meta-analysis suggested that LEV is associated with a lower adverse drug reaction rate and appears to have a similar efficacy to phenytoin for seizure prophylaxis ( 18 ).…”

Complex Febrile Seizures: An Update

“…55 Intermittent oral levetiracetam was found in one study to be efficacious in preventing febrile seizure recurrence with minimal side effects. 56 A recent systematic review of prophylactic drug therapy in children with febrile seizures found reduced recurrence rates in children with continuous phenobarbitone (significant reduction at 6, 12, and 24 months, but not at 18 or 72 months of follow-up) or intermittent diazepam (significant reduction at 12, 24, 36, and 48 months but not at 60-72 months). Both drugs produced mild-to-moderate adverse side effects in up to 30% of children.…”

The Mutual Interaction Between Sleep and Epilepsy on the Neurobiological Basis and Therapy

“…In more tests, however, LEV was reported to disrupt sleep, causing an increase in N2 sleep and a decrease in total sleep time, deep NREM sleep, and REM sleep [ 150 , 151 ]. Most studies pointed to the possibility of daytime drowsiness [ 152 ].…”