Levetiracetam-associated irritability and potential role of vitamin B6 use in veterans with epilepsy

Dreischmeier, Emma; Zuloaga, Andrea; Kotloski, Robert J.; Karasov, Ariela; Gidal, Barry E.

doi:10.1016/j.ebr.2021.100452

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…Adjunctive multivitamin therapy (100 mg vitamin B6, 5 mg vitamin B9, 1000 IU vitamin D, 400 IU vitamin E, and 100 mg Q10) has been shown to be effective for patients with drugresistant focal epilepsy [211]; with a reported decrease in mean seizure frequency from 9 to 2 per month and 63% of subjects reporting a ≥ 50% reduction in seizure frequency at the 6-month follow-up [209]. However, although some studies of patients with epilepsy have identi ied a therapeutic bene it of vitamin B6 supplementation in terms of improved clinical outcomes, this is not the case for every patient [212][213][214][215][216][217][218]. Multiple studies have identi ied vitamin D de iciencies among pediatric and adult patients with epilepsy [219][220][221][222].…”

Section: Epilepsy and Nutrientsmentioning

confidence: 99%

Nutritional interventions for the prevention and treatment of neurological disorders such as anxiety, bipolar disorder, depression, epilepsy, multiple sclerosis, and schizophrenia

Madireddy¹,

Madireddy²

2022

J Neurosci Neurol Disord

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Neurological disorders are a significant cause of mortality and disability across the world. The current aging population and population expansion have seen an increase in the prevalence of neurological and psychiatric disorders such as anxiety, bipolar disorder, depression, epilepsy, multiple sclerosis and schizophrenia. These pose a significant societal burden, especially in low - and middle-income countries. Many neurological disorders have complex mechanisms and lack definitive cures; thus, improving our understanding of them is essential. The pathophysiology of neurological disorders often includes inflammation, mitochondrial dysfunction and oxidative stress. Oxidative stress processes, especially the generation of reactive oxygen species, are key mechanisms in the development of neurological disorders. Oxidative stress refers to an imbalance between the production of reactive oxygen species and antioxidants that can counteract them. Through their impacts on the pathophysiology of neurological disorders, nutrients with anti-inflammatory, neuroprotective and antioxidative properties have been suggested to prevent or mitigate these disorders. Certain vitamins, minerals, polyphenols and flavonoids may have therapeutic effects as adjuvant treatments for neurological disorders. Diet quality is also a risk factor for some neurological and psychiatric disorders and addressing nutritional deficiencies may alleviate symptoms. Therefore, optimizing nutritional intake may represent a potential treatment or prevention strategy. This review summarizes a selection of promising nutrients for the prevention and amelioration of neurological disorders to provide a summary for scientists, clinicians and patients, which may improve understanding of the potential benefits of nutrients in the treatment of neurological disorders.

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Section: Epilepsy and Nutrientsmentioning

confidence: 99%

Nutritional interventions for the prevention and treatment of neurological disorders such as anxiety, bipolar disorder, depression, epilepsy, multiple sclerosis, and schizophrenia

Madireddy¹,

Madireddy²

2022

J Neurosci Neurol Disord

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“…Так, леветирацетам у середній дозі 30-40 мг/кг/добу має високу ефективність і рекомендований як препарат першої лінії при лікуванні ЕЕ з міоклонічними нападами. Леветирацетам призначався в комбінації з вітаміном В 6 для запобігання можливим побічним ефектам препарату у вигляді поведінкових порушень [26]. Найбільша доказова база на сьогодні існує для солей вальпроєвої кислоти в лікуванні генералізованих і фокальних епілептичних нападів, у тому числі тонікоклонічних, клонічних, міоклонічних, а також абсансів.…”

Section: примітки: Esm -етосукцимід; Cbz -карбамазепін; Clb -клоназеп...unclassified

Modern treatment of epileptic encephalopathies in young children: improvement of precision medicine

Kirilova,

Miroshnikov,

Abaturov

et al. 2023

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Background. Treatment of epileptic seizures in young children, especially with epileptic encephalopathies (EE), is a difficult task, which is impossible in modern conditions without the use of a personified (precision) therapy. The diagnostic algorithm for EE must include genetic examination by the next-generation sequencing, which makes it possible to prescribe targeted therapy depending on the genetic etiology of the disorder. The article presents the results of own research on the effectiveness and approaches to targeted therapy of genetic epileptic encephalopathies in young children. Materials and methods. Fifty-eight children aged 0–3 years with clinical manifestations of epileptic encephalopathies, onset of seizures in the first year of life and diagnosed genetic etiology were included in the study. Pathogenic variants in genes associated with the development of epileptic seizures were identified in all children using the next-generation sequencing. The study included assessment of neurological status, history collection, evaluation of semiology and seizure type, development and screening for autism spectrum disorders at the age of 18 and 24 months, video-electroencephalography during night sleep, magnetic resonance imaging of the brain, assessment of antiepileptic treatment received by the child. Results. Of 58 children with EE who were prescribed antiepileptic drugs, 10 (17.2 %) received monotherapy, 40 patients (69 %) received combined therapy with two anticonvulsants, and 8 children (13.8 %) — combined therapy with three or more anticonvulsants. Levetiracetam (31 patients), valproic acid salt preparations (20 cases), topiramate (11 children) and vigabatrin (10 cases) were most used antiepileptic drugs. In all examined patients with EE, we used schemes of targeted (personalized) antiepileptic therapy focused on the genetic etiology of the disorder. In children with tuberous sclerosis caused by mutations in the TSC1 and TSC2 genes, vigabatrin (50–150 mg/kg per day) was included in the antiepileptic therapy and showed efficacy in 75.0 % (9/12) of children with infantile spasms. Corticosteroids (adrenocorticotropic hormone or prednisone) were additionally included in the treatment regimen and showed effectiveness in 66.7 % of cases (4/6). In children with mutations in SCN1A gene, combined therapy including valproic acid, topiramate and clobazam, or valproic acid with levetiracetam and corticosteroids was used, which showed effectiveness in reducing the frequency of seizures in 100 % of cases. Conclusions. Epileptic encephalopathies are a heterogeneous group of genetic disorders in young children that are difficult to treat and often have a malignant course. Since standard antiepileptic drugs are often insufficiently effective in epileptic encephalopathies, the use of targeted therapy drugs and alternative treatments such as hormone therapy are extremely important. The goal of treatment for epileptic encephalopathies is not only to control seizures, but also to prevent the development of neurological and cognitive deficits and restore lost functions.

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“…In addition, patients with frontal lobe tumors may be at increased risk of neuropsychiatric adverse effects with levetiracetam ( Bedetti et al, 2017 ). Add-on treatment with pyridoxine for the control of levetiracetam-induced behavioral adverse effects might be considered in some patients ( Marino et al, 2018 ; Dreischmeier et al, 2021 ).…”

Section: Antiseizure Medication For Brain Tumor-related Epilepsymentioning

confidence: 99%

Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios

et al. 2022

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Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.

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Levetiracetam-associated irritability and potential role of vitamin B6 use in veterans with epilepsy

Cited by 14 publications

References 15 publications

Nutritional interventions for the prevention and treatment of neurological disorders such as anxiety, bipolar disorder, depression, epilepsy, multiple sclerosis, and schizophrenia

Nutritional interventions for the prevention and treatment of neurological disorders such as anxiety, bipolar disorder, depression, epilepsy, multiple sclerosis, and schizophrenia

Modern treatment of epileptic encephalopathies in young children: improvement of precision medicine

Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios

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