levetiracetam and Encephalitis

Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term 'epilepsy' which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level "A") as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient's compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.

Topics: Adolescent; Age Factors; Aged; Aged, 80 and over; Anticonvulsants; Carbamazepine; Drug Administration Schedule; Drug Approval; Drug Prescriptions; Electroencephalography; Encephalitis; Epilepsies, Partial; Humans; Hungary; Isoxazoles; Levetiracetam; Magnetic Resonance Imaging; Medication Adherence; Obesity; Phenytoin; Piracetam; Risk Assessment; Risk Factors; Seizures; Stroke; Weight Loss; Young Adult; Zonisamide

Acute brain inflammation after status epilepticus (SE) is involved in blood-brain barrier (BBB) dysfunction and brain edema, which cause the development of post-SE symptomatic epilepsy. Using pilocarpine-induced SE mice, we previously reported that treatment with levetiracetam (LEV) after SE suppresses increased expression levels of proinflammatory mediators during epileptogenesis and prevents the development of spontaneous recurrent seizures. However, it remains unclear how LEV suppresses neuroinflammation after SE. In this study, we demonstrated that LEV suppressed the infiltration of CD11b

Topics: Animals; Anticonvulsants; Cytokines; Disease Models, Animal; Encephalitis; Levetiracetam; Mice; Monocytes; Neutrophils; Pilocarpine; Proteome; Status Epilepticus

The new severe acute respiratory syndrome- coronavirus 2 is reported to affect the nervous system. Among the reports of the various neurological manifestations, there are a few documented specific processes to explain the neurological signs. We report a para-infectious encephalitis patient with clinical, laboratory, and imaging findings during evolution and convalescence phase of coronavirus infection. This comprehensive overview can illuminate the natural history of similar cases. As the two previously reported cases of encephalitis associated with this virus were not widely discussed regarding the treatment, we share our successful approach and add some recommendations about this new and scarce entity.

Topics: Adult; Anti-Bacterial Agents; Anticonvulsants; Atazanavir Sulfate; Betacoronavirus; Brain; Consciousness Disorders; Coronavirus Infections; COVID-19; Diffusion Magnetic Resonance Imaging; Disease Progression; Encephalitis; Female; Glucocorticoids; HIV Protease Inhibitors; Humans; Hydroxychloroquine; Immunoglobulins, Intravenous; Immunologic Factors; Intensive Care Units; Levetiracetam; Lung; Magnetic Resonance Imaging; Methylprednisolone; Pandemics; Pneumonia, Viral; Pons; Respiration, Artificial; SARS-CoV-2; Seizures; Temporal Lobe; Thalamus; Tomography, X-Ray Computed

Until today, classic human astroviruses have not been associated with central nervous system infections in immunocompetent patients.. A 16-month-old Caucasian girl presented with repetitive generalized seizures with a 4-day history of watery diarrhea, which had already gradually improved. Initially, the prolonged seizures ceased after systemic midazolam treatment and were thought to be fever associated. However, her mental status remained altered, and after seizure recurrence, she was transferred to our pediatric intensive care unit. Seizure control was achieved by a combination of high-dose levetiracetam and phenobarbital, but she remained unconscious. An electroencephalogram at this time revealed generalized high voltage theta activity. All laboratory analyses, including extended blood and cerebrospinal fluid analyses, and a brain magnetic resonance imaging were normal. On day 4, the child gradually became conscious, but was very agitated and not able to walk. Since an electroencephalogram at this time still revealed generalized high voltage theta activity, although she had not received sedative medications for 72 hours, she was diagnosed as having encephalopathy. At that time, results of diagnostic testing of the stool sample were positive for classic astrovirus infection, and we decided to analyze the initially obtained cerebrospinal fluid for astrovirus as well. Cerebrospinal fluid was also found positive for human astrovirus. Sequencing analysis revealed a classic astrovirus genotype 1 with exactly the same nucleotide sequence as in the feces. Clinically, the child gradually improved and was discharged on day 9.. Whereas the new human astrovirus subtypes have been recently associated with central nervous system infection, this is the first case of encephalitis in an immunocompetent child due to classic human astrovirus. Considering that classic human astroviruses are the third most common etiological agents of viral gastroenteritis in children, we believe that human astroviruses as causative agents for central nervous system infections should be considered more often, especially in children and infants with preceding gastroenteritis.

Topics: Anticonvulsants; Astroviridae Infections; Diarrhea; Encephalitis; Feces; Female; Gastroenteritis; Humans; Hypnotics and Sedatives; Infant; Levetiracetam; Mamastrovirus; Phenobarbital; Seizures; Treatment Outcome

A 20-year-old female was hospitalized due to generalized seizure two weeks after an infection. She reported disorientation, neck stiffness and weakness in her legs. MRI FLAIR images and T

Topics: Adult; Autoantibodies; Biomarkers; Brain; Encephalitis; Female; Hemofiltration; Humans; Immunoglobulins, Intravenous; Levetiracetam; Magnetic Resonance Imaging; Methylprednisolone; Myelin-Oligodendrocyte Glycoprotein; Neuroimaging; Optic Neuritis; Piracetam; Pulse Therapy, Drug; Receptors, N-Methyl-D-Aspartate; Treatment Outcome; Young Adult

To clarify the effect of levetiracetam (LEV) for acute and chronic seizure control in acute encephalitis with refractory, repetitive partial seizures (AERRPS).. We retrospectively reviewed the clinical course of six AERRPS cases treated with LEV, and explored the acute phase termination by withdrawal from barbiturate-induced coma under artificial ventilation, and the reduction in seizure frequency during the chronic phase. LEV was administrated orally or via nasogastric tubes as an add-on agent during acute (n=3; age 8-10 years) and chronic (n=3; age 19-30 years) AERRPS.. In the acute phase, administration of LEV (50-60 mg/kg/d) in combination with phenobarbital (n=3; peak 57.9-76.1 μg/ml) and potassium bromide (n=2; 30-36 mg/kg/d)) resulted in successful reduction of intravenous barbiturate dosage and withdrawal from artificial ventilation. In the chronic phase, seizure frequency reduced by >75% for 5-18 months with LEV 750-1500 mg/d.. LEV may affect seizure control in AERRPS, particularly during the chronic phase, through its unique action of inhibition of excitatory neurotransmitter release. The regimen of oral barbiturate, potassium bromide and LEV would be worth for trial during the acute phase of AERRPS.

Topics: Acute Disease; Adolescent; Adult; Anticonvulsants; Bromides; Child; Chronic Disease; Encephalitis; Female; Humans; Levetiracetam; Male; Phenobarbital; Piracetam; Potassium Compounds; Retrospective Studies; Seizures; Status Epilepticus; Young Adult

Hashimoto's encephalopathy (HE) is a rare syndrome of progressive or relapsing-remitting encephalopathy associated with elevated serum anti-thyroid antibody concentrations. It is thought to be an autoimmune process that generally responds well to high-dose corticosteroids and other immunomodulatory therapies. However, some patients are unresponsive to steroids or are unable to receive immune therapy. A viable alternative is needed for this group. Given that seizure and EEG abnormalities are commonly associated with this syndrome, we postulate that treatment with levetiracetam, which has duel anti-inflammatory and anti-seizure mechanisms, might show clinical benefit. We present the cases of two patients who met the criteria for HE but were unable to receive steroids due to labile diabetes. They were both successfully treated with levetiracetam.

Topics: Adult; Anti-Inflammatory Agents; Anticonvulsants; Comorbidity; Diabetes Mellitus; Encephalitis; Female; Hashimoto Disease; Humans; Levetiracetam; Middle Aged; Piracetam

Topics: Aged; Aged, 80 and over; Anticonvulsants; Carbamazepine; Drug Therapy, Combination; Electroencephalography; Encephalitis; Female; Humans; Intracellular Signaling Peptides and Proteins; Lamotrigine; Levetiracetam; Middle Aged; Phenytoin; Piracetam; Proteins; Seizures; Triazines

Topics: Anticonvulsants; Dose-Response Relationship, Drug; Encephalitis; Epilepsies, Myoclonic; Humans; Hypoxia, Brain; Levetiracetam; Piracetam; Treatment Outcome; Unverricht-Lundborg Syndrome