Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam

Rastogi, Vaibhav; Singh, Dipendra; Kaur, Babbaljeet; Arora, Pulkit; Gadikota, Jaya P

doi:10.7759/cureus.2705

Cited by 11 publications

(16 citation statements)

References 10 publications

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“…SV2A targeted by levetiracetam may result in rhabdomyolysis. Upon review of available case studies, there is a correlation between discontinuation of levetiracetam and down-trending creatine kinase (Akiyama et al, 2014;Aslan et al, 2020;Incecik et al, 2016;Isaacson et al, 2014;Kubota et al, 2017;Di Lorenzo & Li, 2017;Moinuddin, 2020;Ramon et al, 2016;Rastogi et al, 2018;Rota et al, down-trending creatine kinase within 24-48 hours of discontinuing levetiracetam similar to clinical evidence reported in this case.…”

Section: Discussionsupporting

confidence: 79%

“…At the time of this submission, a total of 14 published levetiracetam-related rhabdomyolysis reports were available for review (Akiyama et al, 2014;Aslan et al, 2020;Incecik et al, 2016;Isaacson et al, 2014;Kubota et al, 2017;Di Lorenzo & Li, 2017;Moinuddin, 2020;Ramon et al, 2016;Rastogi et al, 2018;Rota et al, 2018;Shahbaz et al, 2017;Singh et al, 2014;Sohn et al, 2017;Thomas et al, 2019). No confirmatory studies are able to prove definitively the mechanism behind levetiracetam-induced rhabdomyolysis, a study by Chakkalakal et al suggests the SV2A protein is localized on certain types of muscle fibre (Chakkalakal et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

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Levetiracetam induced rhabdomyolysis

2021

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Thirty-three-year-old Caucasian male underwent initiation of levetiracetam following witnessed generalized seizure activity at the same time presenting with a right MCA territory ischemic stroke. He then developed elevated CPK and myalgias are highly suspicious for rhabdomyolysis following levetiracetam. Subsequent improvement noted following complete cessation of medication. At follow-up patient reported complete resolution of hemiparesis and myalgias and no new neurological deficits while tolerating valproic acid. This case exemplifies potential rare adverse effect of levetiracetam. Levetiracetam is an antiepileptic medication effective for both generalized and focal types of epilepsy by affecting a broad spectrum of neurotransmitter release via calcium channels GABA receptors and synaptic vessel protein 2A (SV2A). Typical adverse effects include mild dizziness, headache, nausea, somnolence and sometimes hostility. This case provides further evidence of a rare and potentially life-threatening adverse effect of rhabdomyolysis. Further study is needed to possibly detect the exact mechanism resulting in this rare and dangerous adverse effect.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Levetiracetam induced rhabdomyolysis

2021

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“…Rhabdomyolysis has rarely been reported as an adverse effect of levetiracetam and until only eight cases have been reported, all in the setting of seizures- generalised tonic-clonic seizures or partial seizures with secondary generalisation 1 6–12. Details of these eight cases including our case are summarised in table 1.…”

Section: Discussionmentioning

confidence: 95%

Rhabdomyolysis: a rare adverse effect of levetiracetam

Thomas¹,

Mirza

Shaikh

et al. 2019

BMJ Case Rep

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A 62-year-old previously healthy male was admitted with new onset generalised tonic-clonic seizures. Treatment was initiated with the antiepileptic levetiracetam and he had no further episodes of seizures. Creatine kinase (CPK) level was 1812 IU/L 12-hour postadmission. Despite good hydration, his CPK levels continued to rise dramatically and reached a level of 19 000 IU/L on day 5. This rise was unexplained as he did not have any further seizures and had a normal renal function. In the absence of other risk factors, the rare possibility of levetiracetam being responsible for the disproportionately high CPK was considered. Within 12 hours of withdrawal of levetiracetam, there was a downward trend in the CPK levels, with a 10-fold decrease in CPK levels over the next 4 days. This is only the ninth case reported in literature regarding this rare and potentially serious adverse effect of levetiracetam.

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“…Levetirasetamın en bilinen yan etkileri nazofarenjit, sinirlilik, somnolans, asteni/yorgunluk ve baş dönmesi olarak sıralanabilir (6). Hiperpigmentasyon, trombositopeni, lökopeni, anemi ve rabdomiyoliz ise olgu bazında bildirilen nadir yan etkileridir (7)(8)(9). Levetirasetamın karaciğer enzim düzeylerine etki etmemesi, klasik anti-epileptiklerden üstünlüğü olarak belirtilmektedir (10).…”

Section: Discussionunclassified

Levetirasetam kullanan epilepsili bir çocuk hastada hipertransaminazeminin nadir bir nedeni: Salmonella hepatiti

Misirligil

Arslan

Balam

2020

Turkish Journal of Pediatric Disease

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Salmonella hepatiti, salmonella enteritinin karaciğeri tutmasıyla oluşan bir enfeksiyon hastalığı olup akut gastroenterit bulguları ve hipertransaminazemi ile seyreder. Levetirasetam, GABA-glisin sistemini aktive ederek antiepileptik etki gösteren yeni nesil bir antiepileptik ajandır ve nadiren hipertransaminazemiye yol açabilmektedir. Epilepsi tanısıyla 15 aydır levetirasetam kullanmakta olan 11 yaşında bir kız hasta, bulantı-kusma, ateş, karın ağrısı şikayetleriyle birlikte hipertransaminazemi saptanması nedeniyle başvurdu. Salmonella hepatiti tanısı konulan hastada uygun antibiyoterapi ile klinik bulgular gerilemesine rağmen hipertransaminazeminin devamlılığı gözlendi. Persistan hipertransaminazemi etiyolojisi araştırıldı. Etiyolojide salmonella hepatitinin yanı sıra levetirasetam kullanımının yer aldığı görüldü ancak hasta ilaç kesilmeden izlendi. Salmonella enfeksiyonunu takiben 12. haftada normal karaciğer enzim seviyelerine ulaşıldı. Sonuç olarak, levetirasetam kullanan, akut gastroenterit ve hepatit bulgularıyla getirilen hastalarda ilaç tedavisi kesilmeden önce salmonella hepatitinin de ayırıcı tanıda düşünülmesi gerektiği değerlendirilmektedir.

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Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam

Cited by 11 publications

References 10 publications

Levetiracetam induced rhabdomyolysis

Levetiracetam induced rhabdomyolysis

Rhabdomyolysis: a rare adverse effect of levetiracetam

Levetirasetam kullanan epilepsili bir çocuk hastada hipertransaminazeminin nadir bir nedeni: Salmonella hepatiti

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