BACKGROUND: The purpose of this study was to quantitatively assess the subclinical balance dysfunction in elderly people taking antiepileptic drugs. METHODS: We recruited sixty-three patients who were at least 50 years old, without complaint of dizziness or imbalance, and on a stable dose of carbamazepine, lamotrigine or levetiracetam. Their balance scores were compared with those of newly diagnosed untreated age- and sex-matched epilepsy patients (n=21). All the subjects underwent balance measurements that included an activities-specific balance confidence scale, quantitative caloric and rotational chair testing and posturography. The spectral frequency analysis of body sway while standing upright was also investigated. Sensory organization (SOT) and motor control tests were done by computerized dynamic posturography (CDP). RESULTS: The sway distance and area of center of pressure significantly increased in the patients treated with carbamazepine. Spectral frequency analysis of this group showed a significantly increased spectral power at low and middle frequencies on the antero-posterior (Y) plane and at low frequencies on the lateral (X) plane. CDP showed no significant differences in SOT results among the groups. However, motor control test revealed increased latencies and slowed adaptations in the carbamazepine group. CONCLUSIONS: These findings suggest that newer drugs such as lamotrigine or levetiracetam may induce less disequilibrium than carbamazepine in older people on monotherapy for epilepsy. The disturbance is likely related to slowed central postural reflexes.
Aged ; Anticonvulsants ; Carbamazepine ; Cytidine Diphosphate ; Dizziness ; Epilepsy ; Humans ; Piracetam ; Triazines

Hiccups may be considered a form of myoclonus of diaphragm. Valproic acid has been considered the drug of choice in treatment of intractable hiccups; however, its various adverse events limit its use in the clinical basis, especially in elderly or complicated patients. Levetiracetam was known as a safe antiepileptic drug. However, the anti-hiccup property of the levetiracetam has been rarely reported. We report a 69-year old male patient who developed sudden persistent hiccups and was successfully treated with levetiracetam. Levetiracetam should be considered as alternative treatment option in selected patients with intractable hiccups.
Aged ; Diaphragm ; Hiccup ; Humans ; Male ; Myoclonus ; Piracetam ; Valproic Acid

PURPOSE: To evaluate the efficacy and safety of levetiracetam adjunctive therapy for reducing the rate of seizure frequency in children with intractable pediatric epilepsy. METHODS: We reviewed the medical records of 86 patients with intractable pediatric epilepsy who visited our hospital between March 1989 and February 2009. Levetiracetam was included in the previous anticonvulsant regimen for at least 6 months and the reduction in the rate of seizure frequency was determined in follow-up examinations. We analyzed demographic data, seizure types, antiepileptic drug history, levetiracetam dose, adverse effects of levetiracetam therapy, treatment outcome, electroencephalogram findings, etc. RESULTS: More than 50% reduction in the seizure frequency was observed in 62 of the 86 (72.1%) patients; 44 patients (51.1%) became seizure free, while the seizure frequency increased in 5.8% patients. The associations between seizure reduction rate and age, associated diseases, seizure types, and seizure frequency before treatment were not significant. However, the duration of disease, dose of levetiracetam, duration and frequency of anticonvulsant administration before levetiracetam therapy were significantly correlated. Electroencephalogram findings and the cause of epilepsy showed partial correlation. Forty (46%) patients showed adverse symptoms; the symptoms in the order of their frequency were somnolence, hyperactivity, irritability, aggressiveness, tiredness, etc. CONCLUSION: The findings of our study provide the evidence that levetiracetam adjunctive therapy is efficacious and well tolerated in various refractory childhood epilepsy cases.
Child ; Electroencephalography ; Epilepsy ; Follow-Up Studies ; Humans ; Medical Records ; Piracetam ; Seizures ; Treatment Outcome

PURPOSE: Levetiracetam hasa been used in adjuvant therapy. It has also been used in monotherapy in other countries and therefore, we also studied the effect and efficacy of Levetiracetam monotherapy. METHODS: We retrospectively studied the types of epilepsy, EEG, and drug dosage. We studied 101 epilepsy children treated by Levitiracetam monotherapy who had visited our hospital from August 2007 to July 2009. RESULTS: Participants were aged one month to 20 years. The mean age of Levetiacetam therapy was initially 11+/-4 years (from 3 years to 21 years), and the type of epilepsy was partial in 57.4% and generalized in 42.6%. The mean dose I initially began at 6+/-4 mg/kg/day (from 2 mg/kg/day to 30 mg/kg/day) with a mean final dose of 30+/-8 mg/kg/day (from 6 mg/kg/day to 60 mg/kg/day), a mean duration of therapy of 21+/-11months, and a duration of therapy ranging from one to 38months. Further, 60.3% of patients became seizure free and 96.9% exhibited at least a 50% reduction in seizure over a 12 month period. Side effects included behavioral change (8), asthenia (2), cognitive change (1), rash (2), headache (5), inadequate seizure control (2), and increased seizure (5). Levetiracetam was discontinued due to inadequate seizure control (2), increased seizure (5) and side effects (2). CONCLUSION: We studied the efficacy and tolerability of monotherapy of Levetiracetam and found that it was effective and tolerable in monotherapy for epilepsy.
Aged ; Anticonvulsants ; Asthenia ; Child ; Electroencephalography ; Epilepsy ; Exanthema ; Headache ; Humans ; Piracetam ; Retrospective Studies ; Seizures

Levetiracetam has not been reported to cause purpura. We report a case of purpura associated with levetiracetam. A 81-year-old man suffered from post-stroke seizure. Seizure was well controlled with valproate. Valproate was discontinued due to pancytopenia and levetiracetam was prescribed when he was admitted with pneumonia. A few days later, he recovered from pancytopenia and pneumonia. However, he was rehospitalized due to multiple variable sized-purpura on the whole body surface without thrombocytopenia. After discontinuing levetiracetam, purpura disappeared.
Aged, 80 and over ; Humans ; Pancytopenia ; Piracetam ; Pneumonia ; Purpura ; Seizures ; Thrombocytopenia ; Valproic Acid

BACKGROUND: Seizures occur in 2-20% of stroke patients. Recent studies have reported that post-stroke seizures are associated with poorer functional outcomesand higher mortality. However there are no official guidelines on how to use antiepileptic drugs (AEDs) in stroke-related seizures. In this study we surveyed neurologists and neurosurgeons and compared the responses of subgroups categorized by department, specialty and workplace discrimination using a questionnaire containing questions concerning the present tendency to use AEDs in stroke patients. METHODS: 256 neurologists and neurosurgeons participated in the survey. The research instrument was a questionnaire comprising 9 parts and 30 questions. The questions concerned stroke mechanism, the prophylactic use of AEDs, and the choice of AED in early and late onset post-stroke seizures. RESULTS: Tendencies to use prophylactic AEDs in stroke differed depending on specialty and workplace(neurologist vs. neurosurgeon; 17.8% vs. 83.1%, p<0.001, hospital vs. university staff; 46.2% vs. 28.4%, p=0.05). The most commonly used prophylactic AEDs were valproic acid (75%) and levetiracetam (60%). Carbamazepine was the most commonly used AED and phenytoin and phenobarbital were still used in all subgroups to treat post-stroke seizures. CONCLUSIONS: There are significant differences between neurologists (17.8%) and neurosurgeons (83.1%) in the use of prophylactic AEDs after stroke. Valproic acid and levetiracetam are considered first-line prophylactic AEDs by neurosurgeon. Phenytoin and phenobarbital are still used in post-stroke seizure although they have been reported to have an adverse influence on motor recovery. We suggest that proper guidelines should be established for the use of AEDs in stroke-related seizures.
Anticonvulsants ; Carbamazepine ; Discrimination (Psychology) ; Humans ; Phenobarbital ; Phenytoin ; Piracetam ; Surveys and Questionnaires ; Seizures ; Stroke ; Valproic Acid

Levetiracetam is a new antiepileptic drug that is used widely in Korea. It has reported behavioral side effects, most notably irritability, agitation, and aggressive behavior. However, these behavioral side effects are often not considered by prescribers and psychiatrists. We report a 64-year-old male with a cerebral astrocytoma who was referred to the department of psychiatry for increased aggression and irritability. The severity of symptoms did not fluctuate over a 24-hour period, and there was no evidence of depression (Clinical Global Impression of depression severity score: 2). The scores of scales for delirium and cognitive function did not support the possible diagnosis of delirium or dementia [Korean Mini-Mental State Examination (K-MMSE): 25; Korean version of the Delirium Rating Scale-Revised-98: 5]. The severity of aggression was very high in the trait questions of the Korean adaptation of the State-Trait Anger Expression Inventory (STAXI-K: 34). After ruling out dementia, delirium, depression, and an organic mental disorder, we thought that the aggression and irritability might be related to levetiracetam, and recommended discontinuing it without treating the symptoms. After discontinuing the levetiracetam, the patient and caregiver reported a dramatic improvement in the aggression and irritability within 3 days, and the score on the STAXI-K decreased to 10. Twenty-eight weeks follow up after consultation, the STAXI-K was 10, and K-MMSE was increased to 26. We considered a final diagnosis of other substance (levetiracetam)-related disorder not otherwise specified because of the temporal relationship between the use of levetiracetam, occurrence of the symptoms, and improvement on withdrawing the drug. The behavioral side effects of levetiracetam should be considered, especially in patients who develop behavioral changes while taking the drug.
Aggression ; Anger ; Astrocytoma ; Caregivers ; Delirium ; Neurocognitive Disorders ; Dementia ; Depression ; Dihydroergotamine ; Follow-Up Studies ; Humans ; Korea ; Male ; Piracetam ; Psychiatry ; Weights and Measures

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*

BACKGROUND AND PURPOSE: Levetiracetam (LEV) is a new antiepileptic drug that has been found to be effective as an adjunctive therapy for uncontrolled partial seizures. However, the results of several studies suggested that LEV has negative psychotropic effects, including irritability, aggressiveness, suicidality, and mood disorders. We investigated the impact of adjunctive LEV on psychiatric symptoms and quality of life (QOL) in patients with drug-refractory epilepsy (DRE) and determined the risk factors provoking psychiatric adverse events. METHODS: A 24-week, prospective, open-label study was conducted. At enrollment, we interviewed patients and reviewed their medical charts to collect demographic and clinical information. They were asked to complete self-report health questionnaires designed to measure various psychiatric symptoms and QOL at enrollment and 24 weeks later. RESULTS: Seventy-one patients were included in the study, 12 patients (16.9%) of whom discontinued LEV therapy due to serious adverse events including suicidality. The risk factor for premature withdrawal was a previous history of psychiatric diseases (odds ratio 4.59; 95% confidence interval, 1.22-17.32). LEV intake resulted in significant improvements in Beck Anxiety Inventory score (p<0.01) and some domains of the Symptom Checklist-90-Revised, such as somatization (p<0.05), obsessive-compulsiveness (p<0.05), depression (p<0.05), and anxiety (p<0.05). These improvements were not related to the occurrence of seizure freedom. The Quality of Life in Epilepsy Inventory-31 overall score and subscale scores, such as seizure worry (p<0.01), overall QOL (p<0.05), emotional well-being (p<0.05), energy-fatigue (p<0.05), and social function (p<0.05), also improved. CONCLUSIONS: Adjunctive LEV in patients with DRE is likely to improve psychiatric symptoms and QOL. Clinicians should be well aware of the psychiatric histories of patients to prevent them from developing serious adverse events related to LEV.
Anxiety ; Depression ; Epilepsy ; Freedom ; Humans ; Mood Disorders ; Piracetam ; Prospective Studies ; Quality of Life ; Risk Factors ; Seizures ; Suicide ; Surveys and Questionnaires

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