ObjectiveTo compare the curative effect of levetiracetam combined with lamotrigine and sodium valproate on postoperative patients with temporal lobe epilepsy. MethodsA total of 186 postoperative patients with temporal lobe epilepsy during August 2012 to August 2014 in our hospital were divided into levetiracetam combined with lamotrigine group (n=98), and sodium valproate group (n=88) based on postoperative different antiepileptic drugs treatment. Antiepileptic treatment were followed up for 12~48 months.Curative effect and adverse reaction were observed. Reservation rates and incidence rates of adverse reaction were calculated in the two groups. ResultsIn levetiracetam combined with lamotrigine group, EngelⅠratio was 72.4%(71), EngelⅡratio was 17.3%(17), EngelⅢratio was 7.1%(7), and EngelⅣratio was 3.2%(3);in sodium valproate group, EngelⅠratio was 67.0%(59), EngelⅡratio was 21.6%(19), EngelⅢratio was 9.1%(8), and EngelⅣratio was 2.3%(2), and the difference was not statistically significant in the same grade of two groups (P > 0.05).Reservation rate and incidence rate of adverse reaction in levetiracetam combined with lamotrigine group were 90.8%(89) and 15.3%(15) respectively.While those in sodium valproate group were 80.7%(71) and 36.4%(32) respectively.The differences were statistically significant between the two groups (P < 0.05). ConclusionsLevetiracetam combined with lamotrigine treatment on postoperative patients with temporal lobe epilepsy may have better curative effects than sodium valproate treatment, and levetiracetam combined with lamotrigine has its advantage in reservation rate and less adverse reaction.
ObjectiveIt has been reported that many different kinds of antiepileptic drugs (AEDs) induced cutaneous adverse drug reactions (cADRs) are associated with human leukocyte antigen (HLA) genes. However, previous studies mainly focused on the traditional AEDs. There are very few research focused on the new AEDs, especially levetiracetam (LEV). This study aimed to evaluate the clinical characteristics of LEV-induced cADRs and to explore its possible genetic association with the HLA alleles. MethodsNine cases with LEV-induced cADRsfrom September 2011 to December 2014 were recruited. Demographic and clinical information of these cases was summarized. Additionally, cases were matched with LEV-tolerant controls (1 : 4).High-resolution HLA-A, -B, -DRB1 genotyping were performed for each subject. The allele frequencies between the cases and controls were compared. ResultsNine cases with LEV-induced cADRs formed the LEV-cADRs group. And 36 epilepsy patients who had received or have been receiving LEV treatment for at least 3 months without any adverse drug reactions formed the LEV-tolerant controls group. All LEV-induced cADRs were mild skin rashes whichoccurred within 30 days of LEV exposure. The mean latency from LEV exposure to skin rash was (15.67±5.41) days (ranging 6~27). Two patients in the LEV-cADRs group carried the HLA-DRB1*0405allele, while none subjects in the control group carried this allele. The carrier rate of HLA-DRB1*0405 allele between the LEV-cADRs group and control group was statistical significant [P=0.036, OR=13.875, 95%CI(1.273, 151.230)]. ConclusionsSafety monitoring was necessary within four weeks after the initiation of LEV treatment, although it has been regarded as a safe AED.Our study suggested thatHLA-DRB1*0405 allele may be a risk factor for LEV-induced cADRs. However, the Further studies with large samples are needed to clarify this hypothesis and the genetic and immunological mechanisms of LEV-induced cADRs should also be further explored in the future.
Objective To explore the efficacy of low to moderate doses of levetiracetam in adult patients with newly diagnosed partial epilepsy and possible predictors for poor treatment response. Methods We retrospectively analyzed the clinical data of patients treated in West China Hospital from March 2011 to December 2015 whose clinical data were input into the Epilepsy database. Patients with newly diagnosed partial epilepsy and whose initial anti-epileptic drug was levetiracetam were screened out for this study. Their clinical data, especially responses to the treatment of levetiracetam were reviewed. Results Ninety-six patients were included in this study. Seventy-one of them achieved seizure-free for a complete year after initial treatment of levetiracetam. Forty-eight patients (50.0%) achieved seizure-free with levetiracetam monotherapy; 23 patients (24.0%) achieved seizure-free for one year with levetiracetam combination therapy. Sixty-nine (97.2%) of the 71 patients achieved seizure-free with low to moderate doses of levetiracetam (500 to 1 500 mg/day), with or without combination of other antiepileptic drugs. High baseline seizure frequency before initial therapy was an independent predictor of poor levetiracetam response in this multivariate logistic regression mode (P=0.019). Conclusions Low to moderate levetiracetam is both effective and well tolerated in newly diagnosed partial epilepsy patients. High baseline seizure frequency before initial therapy is an independent predictor of poor levetiracetam response.
ObjectivesUsing systematic literature review to analyze the effects of levetiracetam (LEV) on neonatal safety during early pregnancy.MethodsThe scope of the literature must be English literature, published from 1997 to 2018. Meta-analysis was performed by random effects models.ResultsSeven literatures were included. A total of 672 cases exposed to LEV in treatment group and 772 234 cases in control groups were selected for meta-analysis. There was no significant difference in neonatal malignancy between treatment group and control group［OR=1.05, 95% CI (0.54, 2.02), P=0.37］. Further, we evaluated the effect of LEV monotherapy and polytherapy on neonatal safety, a total of 464 monotherapy cases and 632 polytherapy cases respectively were selected for meta-analysis. The results showed that there was no significant difference between these two therapies in neonatal malignancy ［OR=0.54, 95% CI(0.31, 0.96), P=0.32］.ConclusionsAs the papers we included, levetiracetam in the treatment of epilepsy during pregnancy is relatively safe for newborn.
Objective To explore the clinical efficacy of levetiracetam (LEV) in preventing recurrence of complex febrile seizures. Methods 100 children with complex febrile seizures who visited Wuxi Children's Hospital from January 2017 to January 2020 were randomly divided into two groups, observation group (n=50, treated with oral LEV), including 28 males and 22 females, with an average age of (1.57±0.42) years; control group (n=50, treated with oral diazepam), including 26 males and 24 females, with an average age of (1.58±0.39) years. The incidence of adverse reactions, the recurrence rate, EEG changes and neural development after the treatment in both groups were observed. Results After treatment, the incidence of adverse reactions in the observation group was 4.00%, which was significantly lower (P<0.05) than that in the control group (18%). The recurrence rate of the observation group was 2.00%, which was significantly lower (P<0.05) than that in the control group (14%). The incidence of abnormal EEG in the two groups after treatment was lower than that before treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). The results of neurodevelopmental assessment in both two groups were in the normal range before and after treatment, and there was no significant change (P>0.05). Conclusions LEV is effective in the treatment and prevention of complex febrile seizures recurrence, with high safety, less adverse reactions and improved prognosis.
Objective To explore the efficacy and safety of Perampanel (PER) monotherapy in children with focal epilepsy. Methods Forty-six children with focal epilepsy who were newly diagnosed in the Department of Neurology of Wuxi Children's Hospital and had not used anti-seizure medications during January 2021 to June 2022 were selected, including 24 males and 22 females, with an average age of (7.2 ± 2.4) years old. Mono-therapy of PER as the PER group (23 cases), mono-therapy of Levetiracetam (LEV) as the LEV group (23 cases). Compare the clinical efficacy and adverse reactions between the two groups. Result The total effective rate was 87.0% (20/23) in PER group and 73.9% (17/23) in LEV group after 3 months of treatment (P<0.05); the total effective rate in the PER group was 78.3% (18/23), and 60.9% (14/23) in the LEV group after 6 months of treatment (P<0.05). The differences were statistically significant. In the PER group, 2 children had adverse reactions, 1 case was lethargic, and 1 case was dizziness. By temporarily reducing the drug dose and slowing the rate of dosing, the adverse reactions disappeared. In LEV group, 3 children had adverse reactions, all of who were irritable in varying degrees. By slowing down the rate of drug addition, 2 children’s symptoms disappeared and 1 child's symptoms relieved during 3 ~ 6 months. Conclusion The new anti-seizure medication — PER has a better anti-epileptic effect on focal epilepsy, which is better than LEV. The adverse reactions of both drugs are less and mild, and can be selected according to clinical conditions.