levetiracetam and Ataxia

Opsoclonus-myoclonus-ataxia syndrome is a heterogeneous constellation of symptoms ranging from full combination of these three neurological findings to varying degrees of isolated individual sign. Since the emergence of coronavirus disease 2019 (COVID-19), neurological symptoms, syndromes, and complications associated with this multi-organ viral infection have been reported and the various aspects of neurological involvement are increasingly uncovered. As a neuro-inflammatory disorder, one would expect to observe opsoclonus-myoclonus syndrome after a prevalent viral infection in a pandemic scale, as it has been the case for many other neuro-inflammatory syndromes. We report seven cases of opsoclonus-myoclonus syndrome presumably parainfectious in nature and discuss their phenomenology, their possible pathophysiological relationship to COVID-19, and diagnostic and treatment strategy in each case. Finally, we review the relevant data in the literature regarding the opsoclonus-myoclonus syndrome and possible similar cases associated with COVID-19 and its diagnostic importance for clinicians in various fields of medicine encountering COVID-19 patients and its complications.

Topics: Adult; Anticonvulsants; Ataxia; Azithromycin; Clonazepam; Cough; COVID-19; COVID-19 Drug Treatment; Dyspnea; Female; Fever; Humans; Hydroxychloroquine; Levetiracetam; Male; Middle Aged; Myalgia; Opsoclonus-Myoclonus Syndrome; Oseltamivir; SARS-CoV-2; Valproic Acid

In this rare case, the patient presented with opsoclonus, myoclonus and ataxia. Serological and imaging studies revealed high glutamic acid decarboxylase antibody (GAD-Ab) levels. High-dose corticosteroids were of no benefit and subsequent intravenous immunoglobulin (IVIg) administration proved resolution of the condition. Levetiracetam proved useful in symptomatically controlling the myoclonus. Follow-up GAD-Ab levels were within normal limits.

Topics: Adult; Anticonvulsants; Anxiety; Ataxia; Autoantibodies; Diagnosis, Differential; Earache; Female; Follow-Up Studies; Glutamate Decarboxylase; Headache; Humans; Immunoglobulins, Intravenous; Lethargy; Levetiracetam; Meningoencephalitis; Opsoclonus-Myoclonus Syndrome; Piracetam; Treatment Outcome

Topics: Ataxia; Calcium Channels; Humans; Levetiracetam; Mutation; Nystagmus, Pathologic

This study examined the effects of carbamazepine (CBZ) or levetiracetam (LEV) and sub-therapeutic doses of the combination of the two conventional antiepileptics on some of the markers of motor coordination. Twenty-four male Wistar rats (140 ± 5 g) were randomized into 4 groups (n = 6). Group I rats received physiological saline (0.2 ml), group II were administered CBZ (25.0 mg/kg), group III received LEV (50 mg/kg), while group IV rats were given sub-therapeutic doses of CBZ (12.5 mg/kg) and LEV (25 mg/kg) intraperitoneally for 28 days. Thereafter the animals were subjected to behavioral and biochemical investigations, while the frontal lobe and cerebellar tissue were preserved for histological investigation. Data were subjected to descriptive and inferential statistics, and the results presented as mean ± SEM, analyzed using one-way Analysis of variance (ANOVA) and Student- Newman Keuls post hoc analysis where appropriate. p < 0.05 was considered statistically significant. There was significant alteration in fine and skilled movement after the CBZ, and CBZ + LEV chronic treatment compared with the control. The CBZ, and CBZ + LEV combination treatment increased the frontal lobe and cerebellar activities of acetylcholinesterase, malondialdehyde concentration, tissue necrotic factor alpha and decreased the activities of super oxide dismutase relative to the control. Disorganization of the histoarchitecture of the frontal lobe and cerebellum was characterized by cellular atrophy, chromatolysis and hyalinization. Chronic CBZ, and CBZ + LEV combination treatment produced psychomotor dysfunction and neurotoxicity in this order CBZ + LEV > CBZ > LEV in the rats.

Topics: Animals; Anticonvulsants; Ataxia; Carbamazepine; Cerebellar Ataxia; Cerebellum; Drug Therapy, Combination; Levetiracetam; Male; Motor Activity; Piracetam; Rats; Rats, Wistar

Topics: Aged; Anti-Dyskinesia Agents; Anticonvulsants; Antihypertensive Agents; Ataxia; Cerebellum; Dose-Response Relationship, Drug; Drug Administration Schedule; Dyskinesias; Haloperidol; Hemangioma, Cavernous, Central Nervous System; Humans; Hypertension; Intracranial Hemorrhage, Hypertensive; Levetiracetam; Lorazepam; Magnetic Resonance Imaging; Male; Piracetam; Recurrence; Subthalamic Nucleus; Treatment Outcome; Vomiting

Levetiracetam (LEV, [S]-alpha-ethyl-2-oxo-1-pyrrolidine acetamide) is a new antiepileptic that has been used as adjunctive therapy to treat patients with intractable epilepsy. Systemic administration of levetiracetam (2.5-30 mg/kg, intraperitoneally (i.p.)) was able to produce a dose-dependent decrease in DBA/2 audiogenic seizure severity score. In combination with conventional antiepileptic drugs, levetiracetam, 5mg/kg, i.p., which per se did not significantly affect the occurrence of audiogenic seizures in DBA/2 mice, potentiated the anticonvulsant activity of some antiepileptic drugs studied against sound-induced seizures in DBA/2 mice. The degree of potentiation induced by levetiracetam was greater, approximately twice, for carbamazepine, diazepam, felbamate, topiramate, gabapentin, and valproate, less for lamotrigine, phenobarbital and phenytoin. This increase was associated with a comparable impairment in motor activity; however, the therapeutic index of combined treatment of antiepileptic drugs with levetiracetam was more favourable than the combination with saline with the exception of lamotrigine, phenytoin and phenobarbital. Since levetiracetam did not significantly influence the total and free plasma and the brain levels of antiepileptics studied. In addition, levetiracetam did not significantly affect the hypothermic effects of the anticonvulsants tested. In conclusion, levetiracetam showed an additive anticonvulsant effect when administered in combination with some classical anticonvulsants, most notably carbamazepine, diazepam, felbamate, gabapentin, topiramate and valproate, implicating a possible therapeutic relevance of such drug combinations.

Topics: Acoustic Stimulation; Animals; Anticonvulsants; Ataxia; Behavior, Animal; Body Temperature; Brain; Dose-Response Relationship, Drug; Drug Interactions; Epilepsy, Reflex; Levetiracetam; Mice; Mice, Inbred DBA; Motor Activity; Piloerection; Piracetam; Postural Balance; Posture

Topics: Adult; Anticonvulsants; Ataxia; Carbamazepine; Drugs, Generic; Electroencephalography; Epilepsy; Female; Humans; Levetiracetam; Magnetic Resonance Imaging; Piracetam