One month following carbon monoxide poisoning, a 39 year-old man developed incontinence, memory impairment, disorientation and emotional instability. He was hospitalized 7weeks later, and during hospitalization he exhibited myoclonic movements of the neck and lower limbs. He was given piracetam intravenously for 11 days. The myoclonus was significantly reduced by the third day of treatment and had disappeared by the seventh day. There was no recurrence following cessation of treatment.
Adult ; Carbon Monoxide Poisoning/complications* ; Human ; Male ; Myoclonus/drug therapy ; Myoclonus/etiology* ; Piracetam/therapeutic use* ; Pyrrolidinones/therapeutic use*

OBJECTIVETo evaluate of the efficacy and safety of adjunctive levetiracetam (LEV) in children younger than 4 years with refractory epilepsy.

METHODSOne hundred and twelve children at age of 4 months to 4 years with refractory epilepsy received LEV as adjunctive therapy. LEV was administered in two equal daily doses of 10 mg/kg. The dose was increased by 10 mg/kg every week up to the target dose (20-40 mg/kg). The efficacy and tolerability were evaluated.

RESULTSAt an average follow-up period of 13 months (6-22 months), LEV administration was found to be effective in 43 children (38.4%) (responders showing more than a 50% decrease in seizure frequency) and 14 children (12.5%) became seizure-free. Fifty-three children (47.3%) did not respond to the treatment and 2 children (1.8%) worsened. The therapy-related adverse events were mild, including restlessness, reduction in sleep time, night terrors, debility, somnolence, nausea and vomiting. The adverse events were either tolerable or resolved in time with dosage reduction in most of children, and only 3 cases required discontinuation.

CONCLUSIONSLEV as adjunctive therapy is effective and well-tolerated in children younger than 4 years with refractory epilepsy, suggesting that it represents a valid option for the treatment of refractory epilepsy in this age group.

Anticonvulsants ; therapeutic use ; Child, Preschool ; Epilepsy ; drug therapy ; Female ; Humans ; Infant ; Male ; Piracetam ; adverse effects ; analogs & derivatives ; therapeutic use

OBJECTIVELevetiracetam has been widely used for childhood epilepsy, but there is no high quality evidence to support its use. This study performed a systematic review to evaluate the effectiveness and safety of levetiracetam therapy for childhood epilepsy.

METHODSThe papers related to levetiracetam therapy for childhood epilepsy published up to March, 2009 were retrieved electronically from the PubMed, Embase, the Cochrane Library, Chinese Biomedical Database, Wanfang and Weipu Chinese Journals Full-text Database. The relevant papers on randomized control trials (RCTs) or quasi-RCTs were studied by meta analysis.

RESULTSTwo papers that met the inclusion criteria were included. The first paper involved 198 patients, including 108 cases in the levetiracetam therapy group and 97 cases in the placebo group. Seven cases (6.9%) were seizure free in the levetiracetam therapy group compared with 1 case (1%) in the placebo group (p<0.01) 14 weeks after treatment. Levetiracetam therapy decreased significantly the frequency of seizures compared with the placebo treatment. The second paper involved 39 patients, including 21 cases in the levetiracetam therapy group and 18 cases in the oxcarbazepine therapy group. Nineteen cases (90.5%) were seizure-free in the levetiracetam therapy group compared with 13 cases (72.2%) in the oxcarbazepine therapy group (P=0.410) during a follow-up of 12-24 months. The adverse effects in the levetiracetam therapy group were not significantly different from the placebo and the oxcarbazepine therapy groups.

CONCLUSIONSThe current evidence shows that levetiracetam therapy is effective for childhood epilepsy. However, it needs to be proved by the multi-centre, large sample RCTs.

Anticonvulsants ; therapeutic use ; Child ; Epilepsy ; drug therapy ; Humans ; Piracetam ; adverse effects ; analogs & derivatives ; therapeutic use ; Randomized Controlled Trials as Topic

OBJECTIVETo study and compare the prophylatic efficacy of levetiracetam, valproate and phenobarbital on febrile convulsions in rats.

METHODSSixty Wistar rats were randomly administered with levetiracetam (200 mg/kg), valproate (250 mg/kg), phenobarbital (30 mg/kg) or normal saline (8 ml/kg) for 5 days. Five days later, febrile convulsions were induced by hyperthermal bath (45 Celcius degree). The latency, duration and the severity of seizures were observed.

RESULTSIn all the three drug-treated groups, the latency was significantly prolonged, and the duration and the severity of seizures were notably reduced compared with the saline group (P<0.05 or 0.01). The phenobarbital group had the shortest duration of seizures and the least severe seizures among the three drug-treated groups. There were no significant differences between the levetiracetam and valproate groups.

CONCLUSIONSContinuous administration of levetiracetam, valproate or phenobarbital is effective in preventing recurrent febrile convulsions in rats. Phenobarbital appears to be more effective than levetiracetam and valproate. There were no significant differences in the prophylactic efficacy between levetiracetam and valproate.

Animals ; Anticonvulsants ; therapeutic use ; Male ; Phenobarbital ; therapeutic use ; Piracetam ; analogs & derivatives ; therapeutic use ; Rats ; Recurrence ; Seizures, Febrile ; prevention & control ; Valproic Acid ; therapeutic use

OBJECTIVETo study the efficacy of levetiracetam (LEV) in the treatment of electrical status epilepticus during sleep (ESES) in children.

METHODSThe clinical data of 27 children who were newly diagnosed with ESES and treated with LEV between August 2009 and March 2011 and who were followed up for at least 6 months were retrospectively studied.

RESULTSThe onset age of the 27 children ranged from 9 months to 9 years and 7 months. Partial motion seizures were found in 81% of the children in the early stage. Twenty-three children received LEV treatment after ESES was definitely diagnosed. Of the 23 children, 19 were diagnosed as epilepsy syndrome of benign childhood epilepsy with centrotemporal spikes (BECT). The age of the patients at the beginning of LEV treatment ranged from 1 year and 8 months to 11 years and 9 months. The follow- up duration was 7 to 19 months. The effective rate of LEV for seizure control was 82% and for EEG recovery it was 78% (P<0.05). The other 4 children received LEV treatment before the occurrence of ESES. Seizure control and EEG recovery were noted in two of the 4 children.

CONCLUSIONSLEV treatment is efficacious, to some extent, for both seizure control and EEG recovery in children with ESES.

Adolescent ; Anticonvulsants ; therapeutic use ; Child ; Child, Preschool ; Electroencephalography ; drug effects ; Female ; Humans ; Infant ; Male ; Piracetam ; analogs & derivatives ; therapeutic use ; Retrospective Studies ; Status Epilepticus ; drug therapy ; physiopathology

OBJECTIVETo evaluate the efficacy and tolerability of levetiracetam (LEV) in the treatment of epilepsy as a monotherapy in children.

METHODSThirty-two children with epilepsy (age ranged from 8 months to 12 years) and who had received LEV monotherapy were investigated by a self-controlled and open-label research. LEV was administered at a dose of 10 mg/kg.d, and increased by 10 mg/kg.d per week till to the target dose (20-40 mg/kg.d), with a mean dose of 35 mg/kg.d.

RESULTSThirty-one patients were followed up for more than three months. Twenty-five patients (80.6%) had at least 50% reduction in seizures, 22 cases (70.9%) became seizure-free, and LEV therapy was discontinued in 5 patients (16.1%) due to either an inadequate seizure control or aggravated seizures. The therapy-related adverse events included mood and behavioral changes (6/31, 19.4%), asthenia (2/31, 6.5%), somnolence (2/31, 6.5%), and skin rashes (1/31, 3.2%). The adverse effects were spontaneously disappeared or disappeared after reducing the LEV dose.

CONCLUSIONSLEV monotherapy is effective and safe for the control of partial and generalized tonic-clonic seizures in children with epilepsy. LEV appears to be a promising anti-epileptic drug for monotherapy in children with epilepsy.

Anticonvulsants ; therapeutic use ; Child ; Child, Preschool ; Epilepsy ; drug therapy ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Piracetam ; adverse effects ; analogs & derivatives ; therapeutic use

BACKGROUNDIt is important to choose an appropriate antiepileptic drug (AED) to manage partial epilepsy. Traditional AEDs, such as carbamazepine (CBZ) and valproate (VPA), have been proven to have good therapeutic effects. However, in recent years, a variety of new AEDs have increasingly been used as first-line treatments for partial epilepsy. As the studies regarding the effectiveness of new drugs and comparisons between new AEDs and traditional AEDs are few, it is determined that these are areas in need of further research. Accordingly, this study investigated the long-term effectiveness of six AEDs used as monotherapy in patients with partial epilepsy.

METHODSThis is a retrospective, long-term observational study. Patients with partial epilepsy who received monotherapy with one of six AEDs, namely, CBZ, VPA, topiramate (TPM), oxcarbazepine (OXC), lamotrigine (LTG), or levetiracetam (LEV), were identified and followed up from May 2007 to October 2014, and time to first seizure after treatment, 12-month remission rate, retention rate, reasons for treatment discontinuation, and adverse effects were evaluated.

RESULTSA total of 789 patients were enrolled. The median time of follow-up was 56.95 months. CBZ exhibited the best time to first seizure, with a median time to first seizure of 36.06 months (95% confidential interval: 30.64-44.07). CBZ exhibited the highest 12-month remission rate (85.55%), which was significantly higher than those of TPM (69.38%, P = 0.006), LTG (70.79%, P = 0.001), LEV (72.54%, P = 0.005), and VPA (73.33%, P = 0.002). CBZ, OXC, and LEV had the best retention rate, followed by LTG, TPM, and VPA. Overall, adverse effects occurred in 45.87% of patients, and the most common adverse effects were memory problems (8.09%), rashes (7.76%), abnormal hepatic function (6.24%), and drowsiness (6.24%).

CONCLUSIONThis study demonstrated that CBZ, OXC, and LEV are relatively effective in managing focal epilepsy as measured by time to first seizure, 12-month remission rate, and retention rate.

Adolescent ; Adult ; Anticonvulsants ; therapeutic use ; Carbamazepine ; analogs & derivatives ; therapeutic use ; China ; Epilepsies, Partial ; drug therapy ; Female ; Fructose ; analogs & derivatives ; therapeutic use ; Humans ; Male ; Middle Aged ; Piracetam ; analogs & derivatives ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Triazines ; therapeutic use ; Valproic Acid ; therapeutic use ; Young Adult

OBJECTIVETo study the changes in 24-hour video electroencephalogram (EEG) and epileptic attacks after levetiracetam add-on therapy in children with frontal lobe epilepsy and epileptiform discharges.

METHODSA prospective study was carried out in 105 children with the frontal lobe epilepsy who received long-term treatment with 1 or 2 types of antiepileptic drug but still with epileptiform discharges in ECG. Levetiracetam add-on therapy was administered at the initial daily dose of 20 mg/kg (given in 2 doses) for 2 weeks followed by an increase of the dose to 30 mg/kg with a maintenance dose of 30-40 mg/kg. The changes in seizure attacks and 24-hour video-EEG monitoring after a 6-month therapy were observed.

RESULTSLevetiracetam add-on therapy reduced epileptiform discharges in 55 children (52.3%) and resulted in significant changes in EEG (P<0.05). Of the 77 children with clinical seizures, complete seizure control was achieved in 12 cases after the therapy, and the seizure attacks were reduced in 28 cases, showing a total response rate of 51.9%; the reduction in seizure attacks was positively correlated with EEG improvement (P<0.001).

CONCLUSIONLevetiracetam add-on therapy can decrease epileptiform discharges in EEG and reduce clinical seizure attacks in children with frontal lobe epilepsy with only mild adverse reactions.

Adolescent ; Anticonvulsants ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Electroencephalography ; Epilepsy, Frontal Lobe ; drug therapy ; physiopathology ; Female ; Humans ; Infant ; Male ; Piracetam ; administration & dosage ; analogs & derivatives ; therapeutic use ; Prospective Studies ; Treatment Outcome

OBJECTIVEThis study explored the effects of levetiracetam (LEV) on the expression of nerve cell adhesion molecule (NCAM) and growth-associated protein 43 (GAP-43) mRNA in the hippocampus of rats with epilepsy induced by lithium-pilocarpine (Li-PILO) in order to provide a basis for investigating the antiepileptic mechanism of LEV and its doseresponse.

METHODSForty-eight Wistar rats were randomly divided into a normal control, a Li-PILO model and two LEV treatment groups (LEV: 150 and 300 mg/kg) (n=12 each). The LEV treatment groups received LEV by intragastric administration 6 hrs after status epilepticus (once daily for 2 two weeks). The expressions of NCAM and GAP-43 mRNA in the hippocampus was determined by real-time PCR.

RESULTSThe expression of NCAM and GAP-43 mRNA in the Li-PILO model group was significantly higher than in the normal control group (P<0.05). LEV treatment of 150 and 300 mg/kg significantly decreased the expression of NCAM and GAP-43 mRNA compared with the Li-PILO model group (P<0.05). The LEV treatment group at the dose of 300 mg/kg showed significantly lower expression of NCAM and GAP-43 mRNA than the 150 mg/kg LEV treatment group (P<0.05).

CONCLUSIONSLi-PILO can up-regulate the expressions of NCAM and GAP-43 mRNA in the hippocampus of rats with epilepsy. LEV can inhibit the expression of NCAM and GAP-43 mRNA and the effect is associated with the dose of LEV.

Animals ; Anticonvulsants ; therapeutic use ; Epilepsy ; drug therapy ; metabolism ; GAP-43 Protein ; genetics ; Hippocampus ; metabolism ; Male ; Neural Cell Adhesion Molecules ; genetics ; Piracetam ; analogs & derivatives ; pharmacology ; therapeutic use ; RNA, Messenger ; analysis ; Rats ; Rats, Wistar