Levetiracetam in Nonconvulsive Status Epilepticus in Childhood: A Case Report

Abstract

The authors report the case of a child with cerebral palsy and refractory epilepsy who developed nonconvulsive status epilepticus without acute medical cause treated successfully with levetiracetam. In accordance with other studies whose authors hypothesized that aggressive treatment may worsen the prognosis in elderly patients with nonconvulsive status epilepticus, the present authors successfully used a more conservative approach to the treatment of nonconvulsive status epilepticus in their patient. This case suggests that levetiracetam is a useful option for the treatment of nonconvulsive status epilepticus in childhood, in accordance with some authors who have described the anticonvulsant effects of levetiracetam in experimental status epilepticus and in status epilepticus in adults and in children with continuous spike waves during slow sleep.

Review: New treatment options in status epilepticus: a critical review on intravenous levetiracetam

“…The first case reports of LEV in SE used the oral formulation, most often applied via a nasogastric tube in critically ill patients with SE [Bhatia et al 2008;Trabacca et al 2007;Feleppa et al 2006;Saguer et al 2006;Veldkamp and Swart, 2006;Mehta and Wu, 2005;PastorMilan et al 2005;Zaatreh, 2005]. These studies included 15 patients with varied types of SE (nonconvulsive ¼ 11, convulsive ¼ 2, myoclonic with coma ¼ 1, not otherwise specified ¼ 1) and suggested a good clinical efficacy with suppression of seizures in almost all cases and good tolerability of acutely administered and rapidly loaded oral LEV.…”

Status Epilepticus in the PICU: Quieting the Storm

“…However, the evidence supporting its use in pediatric SE is confined to case reports and case series. Levetiracetam has been reported to have efficacy in cases of refractory SE [39][40][41] and also in cases of NCSE [39,42,43]. However, in some series, levetiracetam is reported to have poor efficacy for SE [44].…”

Pharmacotherapy of Epilepsy: Focus on Levetiracetam

“…A majority of studies have shown that levetiracetam has the most benefit for partial seizures but it does have benefit in generalized tonic-clonic seizures, infantile spasms, neonatal seizures, absence seizures, localization related seizures, nonconvulsive status epilepticus and various other epilepsy syndromes. 3,[53][54][55][56][57][58][59] Patients as young as 2 days old have had positive experiences with levetiracetam with few to no adverse effects. Dosages have ranged from 6 mg/kg/day to 314 mg/kg/day and duration was anywhere from 1 week to 3 years.…”

“…All of the available literature in pediatric patients seems to describe the efficacy and benefit of utilizing levetiracetam in pediatric patients for many seizure types including status epilepticus and NCSE. 53,58,59 All of these SE incidences were case reports which described successful seizure control with levetiracetam.…”

“…However, there are 2 successful pediatric cases of levetiracetam use in NCSE and a retrospective analysis of 10 pediatric patients who received IV levetiracetam; 4 for status epilepticus, 1 for neuroprophylaxis and 1for maintenance of acute seizures. 58,59,63 Levetiracetam is frequently utilized off-label in our pediatric intensive care unit for status epilepticus, neurotrauma prophylaxis, seizures due to traumatic brain injury, and refractory seizure of various etiologies. Levetiracetam is especially ideal in this population because of its reliable pharmacokinetics and good tolerability.…”