levetiracetam and Dystonia

Local botulinum toxin injections represent the treatment of choice for most patients with focal dystonia. However, patients with segmental or generalized forms require additional pharmacologic treatment which is often ineffective or limited by intolerable side-effects. An animal study and three case reports suggested antidystonic effects of levetiracetam, a pyrrolidone derivate, whereas a recent open-label study found no improvement in 10 patients with primary idiopathic cervical dystonia. We studied the efficacy of levetiracetam in a daily dose of 3000 mg in 10 consecutive patients with otherwise therapy refractory segmental or generalized dystonia. At 4-week follow-up, none of the patients showed improvement of dystonia, mild side-effects were observed in 3 patients.

Topics: Adult; Aged; Anticonvulsants; Dystonia; Female; Follow-Up Studies; Humans; Levetiracetam; Male; Middle Aged; Piracetam; Treatment Outcome

Dyskinesia is a movement disorder categorized by involuntary movement of muscle. Although dyskinesia can be brought on by taking medications, it can also be a symptom of a variety of diseases. Antiepileptic drug-induced involuntary movements have been well researched. Rare reports have been made for dyskinesia, a type of dystonia caused by phenytoin. The mechanism of its occurrence must be succinctly studied.. A 53-year-old Asian patient taking phenytoin (100 mg twice daily) experienced symptoms of perioral muscle involuntary movement, impaired speech, and generalized tremors and was admitted to the hospital. Brain magnetic resonance imaging showed significant development of encephalomalacia and porencephaly. The serum phenytoin levels were in the toxic range (33 g/ml). These were suggestive of phenytoin-induced dyskinesia. Levetiracetam and clonazepam were initiated, and the patient showed significant improvement in the symptoms.. This case presented a substantial reference value for the differential diagnosis and treatment prognosis of phenytoin-induced dyskinesia. The phenytoin-induced dyskinesia in this patient was successfully reversed with prompt identification and treatment. According to the case study's findings, such people may benefit from periodic therapeutic drug monitoring.

Topics: Anticonvulsants; Dyskinesia, Drug-Induced; Dystonia; Humans; Levetiracetam; Middle Aged; Phenytoin

Secondary paroxysmal dyskinesias (SPDs) are short, episodic, and recurrent movement disorders, classically related to multiple sclerosis (MS). Carbamazepine is effective, but with risk of adverse reactions. We identified 7 patients with SPD among 457 MS patients (1.53%). SPD occurred in face ( n = 1), leg ( n = 2), or arm +leg ( n = 4) several times during the day. Magnetic resonance imaging (MRI) showed new or enhancing lesions in thalamus ( n = 1), mesencephalic tegmentum ( n = 1), and cerebellar peduncles ( n = 5). Patients were treated with clonazepam and then acetazolamide ( n = 1), acetazolamide ( n = 5), or levetiracetam ( n = 1) with response within hours (acetazolamide) to days (levetiracetam). No recurrences or adverse events were reported after a median follow-up of 33 months.

Topics: Acetazolamide; Adult; Anticonvulsants; Cerebellum; Clonazepam; Dyskinesias; Dystonia; Female; Follow-Up Studies; Humans; Levetiracetam; Magnetic Resonance Imaging; Male; Multiple Sclerosis; Piracetam; Tegmentum Mesencephali; Thalamus; Treatment Outcome

Topics: Adult; Anticonvulsants; Autoantibodies; Autoantigens; Brain; Dystonia; Female; Functional Laterality; Humans; Immunosuppressive Agents; Intracellular Signaling Peptides and Proteins; Levetiracetam; Magnetic Resonance Imaging; Methylprednisolone; Piracetam; Positron-Emission Tomography; Proteins; Seizures

Topics: Adult; Anticonvulsants; Basal Ganglia Diseases; Brain; Calcinosis; Central Nervous System Cysts; Dystonia; Female; Gait Disorders, Neurologic; Humans; Infant, Newborn; Infant, Premature; Leukoencephalopathies; Levetiracetam; Magnetic Resonance Imaging; Muscle Spasticity; Neurologic Examination; Piracetam; Seizures; Spinal Puncture; Tomography, X-Ray Computed

Although there are some newly-developed options to treat dystonia, its medical treatment is not always satisfactory. Zolpidem, an imidazopyridine agonist with a high affinity to benzodiazepine receptor subtype ω1, has been reported to improve clinical symptoms of dystonia in some cases. We conducted an open-label study to assess the efficacy of zolpidem in 34 patients with primary dystonia patients, The Burke Fahn Marsden Dystonia Rating Scale (BFMDRS) scores in the patients were decreased from 7.2 ± 7.9 to 5.5 ± 5.0 after zolpidem therapy (P=0.042). Next we evaluated 55 patients with primary and secondary dystonia, 16 of 55 patients (29%) responded to zolpidem, and secondary dystonia, particularly post-traumatic dystonia, was more responsive than primary dystonia (5 of 11 [46%] vs 11 of 44 [25%]). The efficacy of zolpidem was comparable to that of other oral medications in our previous study; 33 of 89 dystonia patients (37%) responded to trihexyphenidil, 13 of 53 (25%) responded to clonazepam, and 4 of 21 (19%) responded to baclofen. In conclusion, our large scale study suggested that zolpidem may be a therapeutic option for dystonia, particularly post-traumatic dystonia.

Topics: Anticonvulsants; Dystonia; GABA-A Receptor Agonists; Humans; Levetiracetam; Piracetam; Pyridines; Zolpidem

Previous examinations demonstrated antidystonic effects of the synaptic vesicle protein 2A (SV2A) ligand levetiracetam in the dt(sz) mutant hamster, an animal model of paroxysmal non-kinesiogenic dyskinesia in which dystonic episodes can be induced by stress. In the present study, we examined the effects of the two new, high affinity SV2A ligands, brivaracetam and seletracetam, in comparison to levetiracetam on the severity of dystonia in mutant hamsters. Seletracetam (50 and 75 mg/kg i.p.) and brivaracetam (75 mg/kg i.p.) reduced the severity of dystonia to a comparable extent as levetiracetam (50 and 75 mg/kg i.p.). These data confirm the therapeutic potential of these pyrrolidone derivatives for the treatment of paroxysmal dystonia.

Topics: Animals; Cricetinae; Disease Models, Animal; Dose-Response Relationship, Drug; Dystonia; Humans; Levetiracetam; Ligands; Membrane Glycoproteins; Nerve Tissue Proteins; Piracetam; Pyrrolidinones; Severity of Illness Index

Sjogren's syndrome (SS), either primary or secondary, is rarely accompanied by CNS complications. We report the exceptional case of a patient with secondary SS, who presented orofacial dystonia as a consequence of her disease. Initial treatment with clonazepam and levetiracetam was unsuccessful. However, dystonia was dramatically improved by a treatment with corticosteroids. This case demonstrates that corticosteroids can be efficacious in the treatment of dystonia related to SS.

Topics: Adrenal Cortex Hormones; Brain; Clonazepam; Dystonia; Dystonic Disorders; Face; Female; Humans; Levetiracetam; Magnetic Resonance Imaging; Middle Aged; Piracetam; Remission Induction; Sjogren's Syndrome; Treatment Outcome

We report the case of a woman with generalized dystonia whose symptoms improved with the use of levetiracetam. Improvements were noted in blepharospasm, cervical, and truncal dystonia. The patient has been on LEV for a total of 20 weeks, and has experienced sustained improvement of symptoms.

Topics: Anticonvulsants; Blepharospasm; Dystonia; Female; Humans; Levetiracetam; Middle Aged; Piracetam

The effects of the nootropic drug piracetam and its analogue, the antiepileptic drug levetiracetam (ucb L059) on severity of dystonic attacks were studied in a mutant hamster model of idiopathic generalized dystonia. Both drugs significantly decreased the severity of dystonia. In contrast to seizure models, in which levetiracetam is much more potent as an anticonvulsant than piracetam, the antidystonic potency of levetiracetam was only moderately higher than that of piracetam. The antidystonic activity of piracetam and levetiracetam was not associated with any behavioral side effects. The data indicate that piracetam and levetiracetam are interesting novel treatments for idiopathic dystonia.

Topics: Animals; Anticonvulsants; Cricetinae; Dystonia; Levetiracetam; Mutation; Nootropic Agents; Piracetam