levetiracetam and Exanthema

Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine-resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time-consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine-resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment.

Topics: Administration, Cutaneous; Administration, Intravenous; Anticonvulsants; Exanthema; Humans; Infusions, Intravenous; Levetiracetam; Phenytoin; Piracetam; Status Epilepticus; Treatment Outcome

Topics: Adult; Anticonvulsants; Exanthema; Female; Humans; Levetiracetam; Male; Piracetam; Seizures; Young Adult

Antiseizure drug (ASD)-induced skin rash remains the main side effect of seizure management in patients with glioma. New generations of ASDs, such as levetiracetam (LEV) and lacosamide (LCM) are associated with less frequent skin rashes than conventional ASDs. However, there are few reports regarding the incidence of skin rashes by LEV and LCM in patients with glioma. Therefore, the aim of this study was to investigate the incidence and risk factors of LEV- and LCM-associated skin rashes in patients with glioma.. We compared the incidence of ASD-associated skin rash between 353 patients with glioma and 125 patients with meningioma, who received LEV or LCM and underwent surgery between 2017 and 2019 at our institution. Furthermore, to evaluate the association between potential risk factors and ASD-associated skin rashes, univariate and multivariate analyses were performed.. The incidence of ASD-associated skin rash in patients with glioma was higher (11 %) than in those with meningiomas (1.6 %). The multivariate regression analysis showed that adjuvant treatment with radiotherapy (p = 0.023) and a history of drug allergy (p = 0.023) were significant risk factors for ASD-associated skin rash. The rate of ASD-related skin rashes in patients with glioma was also higher than the previously reported rates of 1-3 % in patients with epilepsy.. Our results indicate that adjuvant treatment with radiotherapy and a history of drug allergy correlated with a high incidence of ASD-related skin rashes in patients with glioma who receive LEV and LCM. Patients with these two factors should be carefully checked for skin rashes.

Topics: Anticonvulsants; Drug Hypersensitivity; Exanthema; Glioma; Humans; Incidence; Lacosamide; Levetiracetam; Risk Factors

Topics: Diagnostic Tests, Routine; Exanthema; Humans; Levetiracetam; Lupus Erythematosus, Systemic; Pharmaceutical Preparations

Systemic lupus erythematosus (SLE) is a rare autoimmune disorder in a physician's practice, commonly presenting in young females. It is rare for SLE to present at a late age. Though SLE is idiopathic, sometimes it can present as an adverse reaction to drugs. Quite a few drugs are implicated in this process. However, there are no reports of levetiracetam causing SLE. Here, we present a case of 62-year-old female presenting with SLE after consumption of levetiracetam for 1 year for her epilepsy. Erythematosus rash was her main symptom. This was associated with a strong positivity of antinuclear antibody. The symptoms remitted completely after the discontinuation of levetiracetam, suggesting them to be because of drug-induced lupus (DIL). DIL differs from SLE in being mild, affecting atypical age groups and resolving completely on withdrawal of the drug.

Topics: Exanthema; Female; Humans; Levetiracetam; Lupus Erythematosus, Systemic; Middle Aged

We performed observational cohort study to compare the long-term efficacy, tolerability, and safety of oxcarbazepine (OXC), lamotrigine (LTG), and levetiracetam (LEV) monotherapy for newly diagnosed focal epilepsy patients.. Three hundred and eighty eight newly diagnosed focal epilepsy patients aged 1-70 years were enrolled in this study between June 2009 and March 2016. Among the patients, 191 were treated with OXC, 98 were treated with LTG, and 99 were treated with LEV monotherapy. The study was performed in a real-world setting and the primary outcomes were the one-year and three-year seizure-free rates. The secondary outcomes were the one-year and three-year withdrawal rates, the time to treatment withdrawal, the time to the first seizure, and the time to achieve one-year remission.. The three-year seizure-free rates with LTG (39.8 %) and LEV (41.4 %) were significantly better than that with OXC (26.2 %) (both P < 0.05). However, no significant difference was observed among the three drugs for the one-year seizure-free rate. The three-year withdrawal rate was 50.8 %, 46.9 %, and 43.4 % for OXC, LTG, and LEV, respectively (all P > 0.05). The one-year withdrawal rate for OXC (31.7 %) was higher than those for LTG (30.6 %) and LEV (26.3 %) (all P > 0.05). LEV [Relative Risk (RR) = 0.69, 95 % CI: 0.49∼0.99] and LTG (RR = 0.63, 95 % CI: 0.44∼0.9) were significantly better than OXC in preventing first seizure. LEV appears to be the superior option with regard to the time to achieve one-year remission.. The results of the study showed that LEV and LTG are significantly more effective than OXC for the treatment of newly diagnosed focal epilepsy. LEV has milder adverse events than OXC and LTG in clinical practice.

Topics: Adolescent; Adult; Aged; Anticonvulsants; Child; Child, Preschool; Cohort Studies; Dizziness; Drug Administration Schedule; Epilepsies, Partial; Exanthema; Female; Humans; Infant; Lamotrigine; Levetiracetam; Male; Middle Aged; Oxcarbazepine; Time Factors; Treatment Outcome; Young Adult

Antiepileptic drugs (AEDs) are fairly commonly associated with drug induced rash that can be mild to life threatening. Aromatic AEDs are often linked to these skin reactions unlike newer non-aromatic ones such as levetiracetam (LEV), lacosamide and zonisamide. Drug rash including drug-induced hypersensitivity syndrome is a rare complication of LEV use. We report a case of maculopapular skin rash due to LEV with cross-sensitivity with CBZ which has not been reported till date.

Topics: Anticonvulsants; Carbamazepine; Drug Hypersensitivity Syndrome; Exanthema; Humans; Levetiracetam

This study aimed to evaluate the clinical characteristics of levetiracetam (LEV)-induced cutaneous adverse drug reactions (cADRs) and to explore its possible genetic association with the human leukocyte antigen (HLA) genes.. Nine cases with LEV-induced cADRs were recruited. Demographic and clinical information of these cases was summarized. Additionally, cases were matched with LEV-tolerant controls (1:4). High-resolution HLA class I and class II genotyping was performed for each participant. The allele frequencies between the cases and controls were compared.. All LEV-induced cADRs were mild skin rashes which occurred within 28 days of LEV exposure. The mean latency from LEV exposure to skin rash was (15.67±5.41) days (ranging 6-27). The carrier rates of the two alleles, HLA-DRB1*0405 and HLA-DQB1*0401, were higher in cases compared with controls (the same P=0.036, OR=13.875, 95% CI: 1.273-151.230). The association between the HLA-C*0304 allele and LEV-induced cADRs was boundary (P=0.05, OR=5.2, 95% CI: 1.086-24.897). However, the above-mentioned HLA alleles didn't reach statistical significance after multiple comparisons.. Safety monitoring was necessary within four weeks after the initiation of LEV treatment, although it has been regarded as a safe antiepileptic drug. Our study failed to show any potential link between HLA alleles and LEV-induced cADRs in Han Chinese. Further studies are needed to clarify the genetic and immunological mechanisms of LEV-induced cADRs.

Topics: Adult; Anticonvulsants; Asian People; Child; China; Epilepsy; Exanthema; Female; Gene Frequency; Genotyping Techniques; Heterozygote; HLA Antigens; Humans; Levetiracetam; Male; Middle Aged; Piracetam

Neonatal seizures are often refractory to treatment with initial antiseizure medications. Clinicians turn to agents such as levetiracetam despite the paucity of published data regarding its safety, tolerability, or efficacy in the neonatal population.. We describe a neonate who developed anaphylactic shock developing after receiving intravenous levetiracetam.. This is the first neonate to develop anaphylactic shock due to intravenous administration of levetiracetam.. Clinicians should be aware of this potentially fatal adverse effect occurring with intravenous levetiracetam in newborns.

Topics: Anaphylaxis; Anticonvulsants; Asphyxia Neonatorum; Contraindications; Drug Eruptions; Exanthema; Face; Fetal Distress; Humans; Infant, Newborn; Infusions, Intravenous; Leg; Levetiracetam; Piracetam; Pneumothorax; Scalp; Seizures

Allergic reactions to antiepileptic drugs in the form of skin rash are not uncommon but angioedema, an acute life threatening reaction is rare. Angioedema has been reported with the use of oxcarbazepine and carbamazepine. We report a case of a 33-year-old woman with focal epilepsy who developed angioedema following levetiracetam monotherapy. The patient had previous skin rashes with both phenytoin and lamotrigine. Levetiracetam was stopped and she improved after treatment with norepinephrine, antihistamines and corticosteroids.

Topics: Adult; Angioedema; Anticonvulsants; Exanthema; Female; Humans; Lamotrigine; Levetiracetam; Phenytoin; Piracetam; Triazines

Due to less experience with the cross-reactivity of antiepileptic drugs (AEDs) in Chinese population, we surveyed the rates of cross- reactivity of rash among commonly used AEDs in Chinese patients with epilepsy, particularly between the traditional and the new compounds.. We have retrospectively reviewed the medical records concerning all antiepileptic drug treatment in consecutive Chinese patients with epilepsy in our center. The incidence of AED-related rash was determined in 3793 outpatients, taking at least one of the AEDs-carbamazepine (CBZ), valproic acid (VPA), phenytoin (PHT), phenobarbital (PB), clonazepam (CZP), oxcarbazepine (OXC), lamotrigine (LTG), gabapentin (GBP), topiramate (TPM), levetiracetam (LEV) and traditional Chinese medicine (TCM). We have performed telephone interviews among all patients with AEDs-related rash. We described the clinical characteristics of the 18 patients with cross-reactivity involving the AEDs, and the cross- reactivity pattern for CBZ, PHT, OXC, and LTG.. A total of 3.61% (137/3793) of patients experienced a skin rash to at least one AEDs, of these patients, 73 (53.28%) were female and 64 were males (46.72%). While 18 patients had a rash to two or more AEDs. Of patients who had a rash to CBZ and were also prescribed PHT (n = 17), 52.9% had a rash to PHT (abbreviated as CBZ → PHT: 52.9%); of patients who had a rash to PHT and were also prescribed CBZ (n = 13), rate of rash was 69.2% (i.e., PHT → CBZ: 69.2%). Other results: CBZ → LTG: 25% (n = 16); LTG → CBZ: 44.4% (n = 9); CBZ→ OXC: 40% (n = 10); OXC → CBZ: 66.7% (n = 6); LTG → PHT: 20% (n = 5); PHT → LTG: 16.7% (n = 6); OXC → LTG: 25% (n=4); LTG → OXC: 33.3% (n = 3); OXC → PHT: 25% (n = 4); PHT → OXC: 16.7% (n = 6). There was a highly significant mutual risk for cross- reactivity for CBZ and PHT, and OXC, and LTG (p<0.001), mutual risk reached statistical significance for LTG and CBZ (p = 0.01).. Cross-reactivity rates between certain AEDs are high, especially when involving carbamazepine and phenytoin. There were also too few patients with rash to reach definitely conclusions about possible cross-reactivity. Larger numbers of patients would be needed to assess this and the mechanism. Caution should be exercised when prescribing certain AEDs (especially CBZ and PHT, but also OXC, and LTG).

Topics: Adolescent; Adult; Aged; Amines; Anticonvulsants; Carbamazepine; Chi-Square Distribution; Child; China; Clonazepam; Cyclohexanecarboxylic Acids; Exanthema; Female; Fructose; Gabapentin; gamma-Aminobutyric Acid; Humans; Lamotrigine; Levetiracetam; Male; Medicine, Chinese Traditional; Middle Aged; Phenobarbital; Phenytoin; Piracetam; Retrospective Studies; Topiramate; Triazines; Valproic Acid; Young Adult