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Anticonvulsant Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
The frequency of birth defects was not increased in 1,015 infants born after exposure to levetiracetam during the first (Box 9.11). Nonetheless, the nature of the disease being treated (seizure disorder) and the drug (anticonvulsive agent) have raised concerns that infants exposed to levetiracetam during gestation may be at an increased risk of birth defects. However, there was no increased frequency of birth defects in more than 1,000 infants exposed during the first trimester (Box 9.11). Among 87 infants whose mothers took levetiracetam during the first trimester in the Swedish Birth Defects Registry, no birth defects were observed (Kallen, 2019)
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Lamotrigine's potential adverse effects include rash, insomnia and tremor. Doses have to be slowly titrated upwards at two-week intervals and takes around six weeks to reach the lower end of the therapeutic range. Sodium valproate may cause tremor and weight gain. There is some limited evidence from heterogeneous populations (also used as a mood stabiliser) that it could occasionally cause parkinsonism.49 There have been rare reports of valproate-induced hyperammonaemic encephalopathy.50 Carbamazepine tends to be the least well tolerated AED in older people.47,48 It has a higher risk of drug interactions and hyponatraemia (secondary to SIADH).46 It can also cause a rash. It is usually best avoided in older people.39 When prescribed, controlled release formulations may cause fewer adverse effects.43 Gabapentin is associated with weight gain, tremor and ataxia. Possible adverse effects from levetiracetam include reduced concentration, drowsiness, depression, agitation and irritability.39 Psychosis has also been reported with levetiracetam and topiramate.51 Psychiatric disorders were the commonest adverse event with levetiracetam (26–30% of relatively young people in randomised studies).44,45 AEDs can increase the risk of osteoporosis.
Neurotoxicology
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Sean D. McCann, Trevonne M. Thompson
A single retrospective study has attempted to evaluate the efficacy of levetiracetam for treatment of toxin-induced seizures; however, current literature is insufficient to support its use.9 Levetiracetam is thought to act as a neuromodulator through interaction with synaptic vesicle glycoprotein 2A (SV2A), in turn decreasing neurotransmitter release. However, the role of SV2A in synaptic transmission, and thus levetiracetam's pharmacologic mechanism of action, is not fully understood. How the pharmacodynamics of levetiracetam will interact with a particular toxin are difficult to predict, and safety has not been proven in the poisoned patient presenting with seizure. Additionally, the efficacy of levetiracetam in the treatment of toxin-induced seizures remains unclear. Given the availability of safe and effective alternatives, levetiracetam is not currently recommended in the treatment of toxin-induced seizures.
Levetiracetam dosing for seizure prophylaxis in neurocritical care patients
Published in Brain Injury, 2023
Ashley Hedges, Matthew C. Findlay, Gary E. Davis, Brianne M. Wolfe, Gregory W.J. Hawryluk, Sarah T. Menacho, Safdar Ansari
The primary outcome was defined as the combined incidence of clinical (directly observed) and subclinical (detected on electroencephalogram (EEG)) seizures. Clinical seizures were identified from physician documentation, and subclinical seizures were captured from EEG reports. For secondary outcomes, the following were captured: timing of seizure incidence (within 7 days vs. ≥8 days), levetiracetam duration, adverse effects (specifically anemia, leukopenia, thrombocytopenia), and evidence of treatment escalation. Evidence of treatment escalation was assessed as follows: a dose escalation of levetiracetam, addition of another antiepileptic agent, the number of EEGs ordered, or discharge on levetiracetam. To better define the patient population, patient demographics were collected. Information was also collected to further define the levetiracetam usage, including dose per weight of patient and product formulation (intravenous or enteral).
Current and emerging pharmacotherapeutic strategies for Tourette syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
In addition to topiramate, other antiepileptic medications, such as Levetiracetam and Valproate, have been used for the treatment of TS [76]. Levetiracetam is an anticonvulsant medication that acts as a neuromodulator by targeting synaptic vesicle glycoprotein SV2A and reducing neurotransmitter release [77]. Its anti-tic efficacy had mixed results in placebo-controlled trials [78]: one small study showed improvement [79], whereas two others failed to show statistically significant results [80,81]. Like topiramate, valproate is an antiepileptic medication with known GABAergic effects, which are also believed to contribute toward its anti-manic properties. A randomized controlled trial compared intravenous valproate to aripiprazole, showing that both treatments led to significant tic reduction, although the intravenous valproate group responded to treatment faster [82]. Benzodiazepines such as clonazepam are other GABAergic agents for which case reports/series and open-label studies showed potential for tic reduction, in the absence of randomized controlled trials [15,42]. The long-term use of benzodiazepines is limited by their potential to cause tolerance and addiction, as well as by their dose-dependent sedating properties. Baclofen is a centrally acting muscle relaxant that interacts with the GABA-B receptor subtype. This medication was found to improve impairment scores, but not tic severity, in one small randomized controlled trial [83] and may be considered for the treatment of severe muscular tension.
Antiseizure medication-induced obsessive-compulsive disorder and tic disorder: a pragmatic review
Published in Expert Review of Neurotherapeutics, 2022
Minakshi Doobay, Verinder Sharma, Heidi Eccles
Levetiracetam, a novel antiepileptic drug, was approved by the FDA as adjunctive therapy for the treatment of focal seizures, myoclonic seizures, and primary generalized seizure. The search yielded five papers dealing with development of OCS following the use of levetiracetam in adults with seizures [24,35–38]. Two case reports described onset of OCS subsequent to levetiracetam monotherapy or in combination with carbamazepine in patients (including an adolescent) with no personal or family history of psychiatric illness [24,36]. In both cases the levetiracetam dose was 1500 mg/day [24,36]. Another report described the case of a female patient who developed OCD within two months of treatment with levetiracetam 1000 mg/day [35]. The patient required psychiatric hospitalization and treatment with citalopram in combination with olanzapine or risperidone. Substitution of levetiracetam with lamotrigine [24] or carbamazepine [35] resulted in improvement but not complete remission of OCD symptoms.