Levetiracetam in toxic seizures

Lee, Ted; Warrick, Brandon J.; Sarangarm, Preeyaporn; Alunday, Robert; Bussmann, Silas; Smolinske, Susan C.; Seifert, Steven A.

doi:10.1080/15563650.2017.1355056

Cited by 19 publications

(5 citation statements)

References 36 publications

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“…Levetiracetam was the ASM most often used prior to EEG. A study by Lee et al 12 . suggests a benefit of levetiracetam in drug‐provoked seizures.…”

Section: Discussionmentioning

confidence: 99%

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Utility of electroencephalography in toxin‐induced seizures

Sidlak,

Dibble,

Schultz

2024

Academic Emergency Medicine

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IntroductionToxin‐induced seizures differ from seizures occurring in epilepsy and have a high rate of complications. Electroencephalography (EEG) is routinely obtained when there is concern for nonconvulsive status epilepticus (NCSE). The purpose of this study was to characterize the typical findings after toxin‐induced seizures, assess the rate of epileptiform discharges and NCSE, and identify any changes in management resulting from EEG.MethodsPatients older than 16 years who had an EEG during hospitalization for drug‐induced seizure or seizure‐like activity were included. We reviewed 10 years of data (2013–2022) across our hospital system (four community hospitals and one academic center). Patients with a history of seizures and those with cardiac arrest prior to EEG were excluded. The primary outcome was incidence of epileptiform discharges on EEG. The secondary outcome was number of antiseizure medications (ASM) added after EEG.ResultsA total of 256 encounters were screened with 83 patient encounters included. A total of 53% (44/83) of EEGs showed some degree of generalized slowing. A total of 2.4% (2/83) of cases had epileptiform activity on EEG. No cases of nonconvulsive status were identified. No ASM was started in the two cases where epileptiform discharges were identified.ConclusionsDuring usual care of toxin‐induced seizures, epileptiform discharges are uncommon.

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“…Levetiracetam was the ASM most often used prior to EEG. A study by Lee et al 12 . suggests a benefit of levetiracetam in drug‐provoked seizures.…”

Section: Discussionmentioning

confidence: 99%

“…Levetiracetam was the ASM most often used prior to EEG. A study by Lee et al 12 suggests a benefit of levetiracetam in drugprovoked seizures. However, nearly half of patients in this study had a history of seizures thus differentiating it from our patient population.…”

Section: Categorymentioning

confidence: 99%

Utility of electroencephalography in toxin‐induced seizures

Sidlak,

Dibble,

Schultz

2024

Academic Emergency Medicine

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“…It demonstrated no evidence of a difference in adverse event, severe, life‐threatening adverse event rate or dropout rate, and therefore this combination did not appear superior in effectiveness. Levetiracetam is routinely prescribed in some United Kingdom accident and emergency departments for treatment and secondary prophylaxis of alcohol withdrawal seizures, often without benzodiazepines, perhaps because of a perceived reduced abuse liability or perhaps because of uncertainty regarding the seizure's cause and a perception of general efficacy in seizure termination [45]. There was no evidence to support this practice.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness and tolerability of anti‐seizure medication in alcohol withdrawal syndrome: a systematic review, meta‐analysis and GRADE of the evidence

2021

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Background and Aims Anti-seizure medications (ASMs) have been used historically as treatment options in alcohol withdrawal syndrome (AWS). In the past 10 years, there have been no large-scale meta-analyses comparing ASMs with placebo or the current AWS treatment standard, benzodiazepines. We aimed to evaluate the efficacy and tolerability of ASMs in AWS. Methods Systematic review and meta-analysis of randomised controlled trials (RCTs) via searching Medline, Embase and PsychINFO from database inception to March 2020 involving adults age >18 years with AWS. We included 24 RCTs reporting on a total of 2223 participants. Efficacy outcomes included the number of participants experiencing AWS related seizures or delirium, Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) score reduction and rescue medication requirements. Tolerability outcomes included adverse event rate and dropout because of adverse events, alongside severe and life-threatening adverse event rates. Quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). ResultsThere was no evidence of significant improvements in any efficacy outcomes when comparing ASMs with placebo or benzodiazepines. When compared with benzodiazepines, ASMs demonstrated significantly increased odds of requiring rescue medications (OR = 3.50, 95% CI = 1.32, 9.28; P = 0.012). When comparing ASMs with placebo, there were significantly more dropouts because of adverse events (OR = 1.86, 95% CI = 1.05, 3.28; P = 0.034). Most results were of very low quality with the majority of included studies conducted before 2000. Conclusions This systematic review and meta-analysis found no evidence to support general first line clinical use of anti-seizure medications in alcohol withdrawal syndrome treatment.

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“…In 2020, LEV has brought net sales of 788 million euros for UCB 6 . LEV has exhibited several unique merits, including potent activity, 7 minimal side effects, good tolerance, and wide applicability, even for infants and children 8–11 …”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5] In 2020, LEV has brought net sales of 788 million euros for UCB. 6 LEV has exhibited several unique merits, including potent activity, 7 minimal side effects, good tolerance, and wide applicability, even for infants and children. [8][9][10][11] Until now, there have been many reports on the preparation methods of LEV at home and abroad, including optical resolution of etiracetam by means of preparative high-performance liquid chromatography, 12 metalcatalyzed asymmetric hydrogenation, 13 proline-catalyzed α-aminooxylation, 14 and palladium-catalyzed asymmetric synthesis.…”

Section: Introductionmentioning

confidence: 99%

The optimized biocatalytic synthesis of (S)‐methyl 2‐chlorobutanoate by Acinetobacter sp. lipase

Zhan

Song

et al. 2022

Chirality

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Epilepsy is a chronic disease caused by sudden abnormal discharge of brain neurons, leading to transient brain dysfunction. Levetiracetam, developed by the UCB company in Belgium, is an effective drug for the treatment of epilepsy. (S)‐Methyl 2‐chlorobutanoate is an important chiral building block of levetiracetam, which has attracted a great deal of attention. In this study, a strain of lipase‐produced Acinetobacter sp. zjutfet‐1 was screened from soil samples. At optimized conditions for fermentation and biocatalysis, the bacterial lipase exhibited high catalytic activity for hydrolysis and stereoselectivity toward racemic methyl 2‐chlorobutanoate. When the enzymatic reaction was carried out in 6% of racemic substrate, the enantiomeric excess (e.e.s) reached more than 95%, with a yield of over 86%. Therefore, this lipase can efficiently resolve racemic methyl 2‐chlorobutanoate and obtain (S)‐methyl 2‐chlorobutanoate, which presents great potential in the industrial production of levetiracetam.

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Levetiracetam in toxic seizures

Abstract: Levetiracetam used as a second-line agent was associated with control of drug-induced seizures and prevention of seizure recurrence without obvious adverse effects. A prospective study is needed to confirm these results.

Cited by 19 publications

References 36 publications

Utility of electroencephalography in toxin‐induced seizures

Utility of electroencephalography in toxin‐induced seizures

The effectiveness and tolerability of anti‐seizure medication in alcohol withdrawal syndrome: a systematic review, meta‐analysis and GRADE of the evidence

The optimized biocatalytic synthesis of (S)‐methyl 2‐chlorobutanoate by Acinetobacter sp. lipase

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