Neuropsychiatric Complications of Levetiracetam in Children with Epilepsy
Keppra® or Levetiracetam is one of the newer anti-epileptic drugs (AEDs).[P06.091]
Neuropsychiatric Complications of Levetiracetam in Children with Epilepsy
Guillermo M. Estrada, Diane Wildrick, Michael Pranzatelli, Springfield, IL Summary:
Purpose: Levetiracetam, (Keppra, (S)-a-ethyl-2-oxo-1-pyrrolidine acetamide. Is a new and novel antiepileptic drug with an interesting history, and unique properties suggesting that is may be well suited for treatment in children. Keppra use is associated with the occurrence of central nervous system adverse events that can be classified in the following categories: 1. - Somnolence and fatigue. 2. – Coordination difficulties, and 3. - Behavioral abnormalities. In this study we investigated Neuropsychiatric events in children with epilepsy treated with Keppra.
Methods: The records of children with epilepsy treated with levetiracetan at SIU (Southern Illinois University) pediatric clinic from 1998 to June 2002.We evaluated them with regard of demographics, type of seizures, frequency of seizures, family history of seizures, history of mental disorders, family hx of mental disorders, doses of keppra, and duration of treatment, other therapies, including antiepileptic drugs , CBC, complete metabolic panel, liver function test, MRI-CT of brain, EEG.
Results: Of 22 children, eleven were males and eleven were females. The mean age was 12.5 4.2 years (SD), range 4 to 19 years. 5 were on levetiracetam monotherapy. The rest were on combination therapy (zonisimide, divalproexsodium, topiramate, gabapentin lamotrigine, clonazepam, oxcarbazepine, carbamazepine, phenytoin, clonazepan and ketogenic diet). Only four were taking three or more antiepileptic drugs.
Type of seizure as follow: Thirteen had complex partial seizures with and without generalization, 3 had generalized seizures, 3 had juvenile myoclonic epilepsy, 1 had benignrolandic epilepsy, 1 had petit mal, 1 had progressive myoclonus.
The Mean dosage of levetiracetan was 35 mg/kg, standard deviation 13 mg/kg, range11mg/kg to 55 mg/kg. The average length of time the children were on levetiracetam was 44 weeks, standard deviation 37.7, and range 1 week to over 2 years.
Sixteen patient 72.6% treated with levetiracetam, experienced side effects among them fourteen patients 87.5% experienced aggressive behavior, which required cessation of the drug. Seventeen patients 77.3% had prior neuropsychiatric illness (Attention deficit hyperactive disorder (ADHD), developmental delay (DD), mental retardation (MR), cerebral palsy(CP), learning disabilities, headache, hearing loss, anoxic brain injury, depression, microcephaly, tuberous sclerosis, autism, Rett syndrome, and tremor).
Even in absence of neuropsychiatric disorder 40% of children with epilepsy on levetiracetam developed behavioral changes. All abnormalities were reversible.
Conclusion: Levetiracetam is associated with high incidence of psychiatric symptoms in children with epilepsy. Pre-selection of children to avoid comorbid neuropsychiatric disorders is important to the safe use of levetiracetam.
Category – Epilepsy
SubCategory - Therapeutics