Monotherapy for partial epilepsy: focus on levetiracetam

Abstract

Levetiracetam (LEV), the S-enantiomer of alpha-ethyl-2-oxo-1-pyrollidine acetamide, is a recently licensed antiepileptic drug (AED) for adjunctive therapy of partial seizures. Its mechanism of action is uncertain but it exhibits a unique profi le of anticonvulsant activity in models of chronic epilepsy. Five randomized, double-blind, placebo-controlled trials enrolling adult or pediatric patients with refractory partial epilepsy have demonstrated the effi cacy of LEV as adjunctive therapy, with a responder rate (Ն50% reduction in seizure frequency) of 28%-45%. Long-term effi cacy studies suggest retention rates of 60% after one year, with 13% of patients seizure-free for 6 months of the study and 8% seizure-free for 1 year. More recent studies illustrated successful conversion to monotherapy in patients with refractory epilepsy, and its effectiveness as a single agent in partial epilepsy. LEV has also effi cacy in generalized epilepsies. Adverse effects of LEV, including somnolence, lethargy, and dizziness, are generally mild and their occurrence rate seems to be not signifi cantly different from that observed in placebo groups. LEV also has no clinically signifi cant pharmacokinetic interactions with other AEDs, or with commonly prescribed medications. The combination of effective antiepileptic properties with a relatively mild adverse effect profi le makes LEV an attractive therapy for partial seizures.

Chronic histopathological effects of levetiracetam on some internal organs of adult albino rats

“…It has greatly increased the treatment options available to patients with generalized epilepsies 1 and refractory epilepsy. 2 Levetiracetam {(S)-a-ethyl-2-oxo-pyrrolidine acetamide} is an analog of piracetam. 3 It is rapidly and completely absorbed after oral administration and it is predominantly eliminated as unchanged drug in the urine.…”

Post‐ictal psychosis in a patient with a history of nocturnal epilepsy

“…31 However, the use of levetiracetam may present with certain difficulties in terms of its association with certain psychiatric side-effects such as anxiety, irritability, agitation and mood changes. 32 A study from 2005 suggests that the addition of vitamin B6 may reduce the emergence of psychiatric symptoms, 33 although offering further medication may have proven unfruitful in this case, given the extent of the patient's non-compliance.…”

Levetiracetam May be the First Choice for Managing Epilepsia Partialis Continua Related to Ischemic Stroke

“…In addition, Levetiracetam seems to be well tolerated by most patients and may have less adverse effects on cognition than traditional antiepileptic drugs. These advantages of levetiracetam make it a good first line or adjunctive therapy choice for epileptic seizures (6).…”