levetiracetam and Cerebrovascular-Disorders

Although epilepsy was believed to have the highest incidence in childhood, recent epidemiologic studies revealed that the incidence increases markedly in elderly. At least 1% of elderly people are estimated to have epilepsy. Cerebrovascular disease is the most common underlying cause although 25% of new onset geriatric epilepsy cases have no obvious etiology. The most common seizure manifestation is atypical complex partial seizures with long-lasting postictal confusion which may lead to underdiagnosis and misdiagnosis. Factors complicating the treatment of geriatric epilepsy include comorbidities, drug interactions due to polytherapy, and aging-related changing of pharmacokinetics. Individualization of dosage and avoidance of unnecessary polypharmacy are essential for safe utilization of anti-epileptic drugs. New generation drugs such as gabapentin and levetiracetam are better tolerated for elderly people.

Topics: Aged; Aged, 80 and over; Aging; Amines; Anticonvulsants; Cerebrovascular Disorders; Comorbidity; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Drug Interactions; Epilepsy; Gabapentin; gamma-Aminobutyric Acid; Humans; Levetiracetam; Pharmacokinetics; Piracetam

To retrospectively evaluate the pharmacological profiles of antiepileptic drugs (AEDs) in epilepsy patients during haemodialysis using therapeutic drug monitoring data. The serum concentration of AEDs was collected before and after haemodialysis, and the clearance rate and concentration-to-dose ratio were calculated as pharmacological parameters. Thirty-six patients were enrolled in the study (25 males, 11 females; age: 65.3 ± 14.8 years). In 24 of the 36 patients, epilepsy was associated with cerebrovascular disorders, and diabetes was the most common reason for haemodialysis in 16 patients. With regards to seizure type, focal aware seizures were less frequent than focal impaired awareness seizures and focal-to-bilateral tonic-clonic seizures. Interictal EEG showed intermittent rhythmic slow waves and intermittent slow waves more often than spikes or sharp waves. Levetiracetam was the most commonly used AED and led to the highest percentage of responders (80%; 16/20 patients). However, the clearance rate of levetiracetam during dialysis was highest among the antiepileptic drugs used, requiring supplementary doses after haemodialysis in all 20 patients. Valproic acid was not effective for focal epilepsy for patients on haemodialysis, and non-responders to phenytoin had low serum concentration of phenytoin both before and after haemodialysis. The pre-haemodialysis concentration of levetiracetam tended to be higher than the reference range, suggesting a potential risk of overdosing before haemodialysis. The pre- and post-haemodialysis concentrations of valproic acid tended to be lower than the reference range, suggesting a potential risk of underdosing. The concentration-to-dose ratios for levetiracetam, valproic acid, phenytoin, and carbamazepine were significantly lower after than before haemodialysis. The majority of patients with epilepsy on haemodialysis had cerebrovascular diseases, and therapeutic drug monitoring for levetiracetam, valproic acid, and phenytoin, before and after haemodialysis, is needed to ensure proper dosing.

Topics: Aged; Anticonvulsants; Cerebrovascular Disorders; Comorbidity; Drug Monitoring; Epilepsy; Female; Humans; Levetiracetam; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Seizures

Since its introduction in 2006, 43 patients with various forms of status epilepticus (SE) have been treated with the intravenous formulation of levetiracetam (LEV) in our clinic. After ineffective treatment with benzodiazepines, intravenous LEV was administered as a short infusion (nonconvulsive and subtle SE) at a dose of 1000 or 2000 mg. In cases of convulsive SE, a fractionated injection of 1000 or 2000 mg was used. When the results for both are combined, SE could be terminated in 19 of 43 patients. Intravenous LEV was more effective in simple focal SE (3/5), complex focal SE (11/18) and myoclonic status (2/2) than in nonconvulsive (2/8) and subtle (1/2) SE. In no case was (secondarily) generalized convulsive status epilepticus (0/8) terminated. Intravenous LEV was also well-tolerated when injected in fractionated form. No severe adverse reactions were observed. As a result of this investigation, intravenous LEV in moderate doses may represent an efficacious and well-tolerated alternative for the treatment of focal (simple and complex focal) and myoclonic SE. Further investigations are needed to confirm this assumption as the patient numbers are quite low.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Anticonvulsants; Cerebrovascular Disorders; Epilepsies, Myoclonic; Epilepsies, Partial; Female; Germany; Humans; Injections, Intravenous; Levetiracetam; Male; Middle Aged; Piracetam; Status Epilepticus