Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures

Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatric Critical Care Medicine (Impact Factor: 2.34). 04/2009; 10(4):505-10. DOI: 10.1097/PCC.0b013e3181a0e1cf
Source: PubMed


Intravenous (IV) levetiracetam (LEV) is approved for use in patients older than 16 years and may be useful in critically ill children, although there is little data available regarding pharmacokinetics. We aim to investigate the safety, an appropriate dosing, and efficacy of IV LEV in critically ill children.
We describe a cohort of critically ill children who received IV LEV for status epilepticus, including refractory or nonconvulsive status, or acute repetitive seizures.
There were no acute adverse effects noted. Children had temporary cessation of ongoing refractory status epilepticus, termination of ongoing nonconvulsive status epilepticus, cessation of acute repetitive seizures, or reduction in epileptiform discharges with clinical correlate.
IV LEV was effective in terminating status epilepticus or acute repetitive seizures and well tolerated in critically ill children. Further study is needed to elucidate the role of IV LEV in critically ill children.

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    • "Animal models show that the affinity for SV2A is associated with protection against seizures making it an important target for new AEDs (4). In vitro studies demonstrated oppositional activity to negative modulators of gamma-aminobutyric acid (GABA)-gated currents despite lack of binding affinity to GABA receptors (5, 6). "
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    ABSTRACT: Status epilepticus and acute repetitive seizures still pose a management challenge despite the recent advances in the field of epilepsy. Parenteral formulations of old anticonvulsants are still a cornerstone in acute seizure management and are approved by the FDA. Intravenous levetiracetam (IV LEV), a second generation anticonvulsant, is approved by the FDA as an adjunctive treatment in patients 16 years or older when oral administration is not available. Data have shown that it has a unique mechanism of action, linear pharmacokinetics and no known drug interactions with other anticonvulsants. In this paper, we will review the current literature about the pharmacology and pharmacokinetics of IV LEV and the safety profile of this new anticonvulsant in acute seizure management of both adults and children.
    Frontiers in Neurology 12/2013; 4:192. DOI:10.3389/fneur.2013.00192
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    • "It has favourable pharmacokinetic characteristics such as good bioavailability , insignificant protein binding, low drug interactions, and is not affected by hepatic metabolism and demonstrates rapid achievement of steady-state concentrations (Hovinga, 2001). Since the introduction of the intravenous formulation, multiple case reports and case series show good seizure control after intravenous levetiracetam infusion in children with status epilepticus (Alehan et al., 2008; Goraya et al., 2008; Abend et al., 2009). In our case, even though the levetiracetam peak occurs one hour after the infusion , we observed clinical and EEG improvement 10 minutes after the intravenous infusion was initiated. "
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    ABSTRACT: We present the first reported case of a rapid clinical and electroencephalographic response to intravenous levetiracetam infusion of myoclonic status epilepticus in a patient with progressive myoclonus epilepsy due to Gaucher disease. Under continuous video-EEG monitoring, the clinical myoclonic status and the electrographic ictal discharges resolved within 10 minutes after the infusion was initiated. The patient tolerated the treatment well without any reported side effects. This case suggests that levetiracetam may be a safe, effective, and well tolerated intravenous drug in patients with metabolic myoclonic status epilepticus such as Gaucher disease.
    Epileptic disorders: international epilepsy journal with videotape 05/2012; 14(2):155-8. DOI:10.1684/epd.2012.0501 · 0.95 Impact Factor
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    ABSTRACT: Status epilepticus (SE) still results in significant mortality and morbidity. Whereas mortality depends mainly on the age of the patient as well as etiology, morbidity often results from a myriad of complications that occur during prolonged admission to an intensive care environment. Although SE is a clinical diagnosis in most cases (convulsant), its treatment requires support by continuous electroencephalographic recording to ensure cessation of potential nonconvulsive elements of SE. Treatment must be initiated as early as possible and consists of benzodiazepine administration and supportive measures for the airway and circulation. These initial interventions are followed by effective intravenous antiepileptic drugs. If the SE becomes refractory, more complex intensive care interventions, such as induction of barbiturate coma, need to be pursued. Data regarding the role of more recently available antiepileptic drugs in treating SE also are discussed in this review.
    Current Neurology and Neuroscience Reports 01/2006; 9(6):469-476. DOI:10.1007/s11910-009-0069-7 · 3.06 Impact Factor
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