levetiracetam and Learning-Disabilities

The purpose of this prospective, open-label pilot study was to determine whether treatment with levetiracetam improves neuropsychological functioning in children and adolescents who have evidence of subclinical spike production associated with attention and learning difficulties. Six participants (mean age 9.8 years) were treated with levetiracetam up to 40 mg/kg per day and evaluated using neuropsychological (Wide Range Assessment of Memory and Learning, Second Edition), academic (Wechsler Individual Achievement Test, Second Edition, Abbreviated), and electroencephalographic assessments at baseline and after 10 weeks of treatment. Statistically significant improvements on indexes of the Wide Range Assessment of Memory and Learning, Second Edition were observed in 4 participants after 10 weeks. No statistically significant differences were observed for the Wechsler Individual Achievement Test, Second Edition, Abbreviated. Concomitant spike suppression was observed. Levetiracetam was generally well tolerated. A subset of patients exists with attention and learning problems that have associated aberrant cortical electrical activity without clinical seizures and associated neuropsychological deficits that may improve after treatment with levetiracetam.

Topics: Adolescent; Anticonvulsants; Attention; Attention Deficit and Disruptive Behavior Disorders; Brain; Child; Electroencephalography; Epilepsy; Female; Humans; Learning Disabilities; Levetiracetam; Male; Memory; Neuropsychological Tests; Pilot Projects; Piracetam; Prospective Studies; Treatment Outcome

We describe a group of 26 children with no prior history of seizures consistent with benign rolandic epilepsy who had rolandic spikes found coincidentally on EEG. A retrospective chart review as well as phone and email follow-ups with families were completed to assess long-term outcomes. A subset of this group (n=7) with reported comorbid language or learning difficulties was then given an empiric trial of levetiracetam. Seven (27%) children eventually developed seizures, with a median of 14months after the abnormal EEG. Of the 7 children ever treated with levetiracetam, 5 exhibited beneficial effects on learning, speech, or behavior. Side effects reported were mild and included irritability and headache. Incidental rolandic spikes may represent a discrete neurologic condition, with approximately one-quarter of the patients later developing epilepsy. Some of these children may experience improved intellectual functioning with levetiracetam.

Topics: Anticonvulsants; Child; Child, Preschool; Electroencephalography; Epilepsy, Rolandic; Female; Follow-Up Studies; Headache; Humans; Irritable Mood; Language Development Disorders; Learning Disabilities; Levetiracetam; Longitudinal Studies; Male; Piracetam; Retrospective Studies; Treatment Outcome

The aim of this audit was to ascertain outcomes for people who had taken or who were still taking three "new generation" broad-spectrum antiepileptic drugs (AEDs), namely lamotrigine, levetiracetam and topiramate. Thirteen percent of people became seizure free and approximately, one-third had a reduction of greater than 50% in their seizures. Two-thirds of people were still taking their audit AED. In addition, approximately one-third of people with a learning disability derived substantial benefit, although the rate of seizure freedom was lower. All three AEDs were most successful at treating primary generalised epilepsy and least successful with symptomatic generalised epilepsy. With some reservations the data suggests that levetiracetam and topiramate are the most efficacious AEDs, but topiramate is the least well tolerated. These results mean consideration of a "general prescribing policy" is important when using and choosing these AEDs. We conclude that lamotrigine, levetiracetam and topiramate are useful additions to the armamentarium of AEDs.

Topics: Adult; Aged; Anticonvulsants; Cohort Studies; Drug Utilization; Epilepsy; Epilepsy, Generalized; Female; Fructose; Hospitals, General; Humans; Knowledge Bases; Lamotrigine; Learning Disabilities; Levetiracetam; Male; Medical Audit; Middle Aged; Patient Dropouts; Piracetam; Topiramate; Triazines; United Kingdom

To investigate the prevalence and psychopathological features of psychiatric adverse events (PAEs) in patients with learning disabilities (LD) in therapy with levetiracetam (LEV).. From a population of 517 consecutively patients with epilepsy started on LEV, we identified 118 patients with epilepsy and LD.. Fifteen patients (12.7%) experienced PAEs during LEV therapy. Two (1.7%) developed an affective disorder, nine (7.6%) aggressive behaviour, two (1.7%) emotion lability and two (1.7%) other personality changes such as agitation, anger and hostile behaviour. We observed a significant association with a previous history of status epilepticus and a previous psychiatric history. We did not find a statistically significant association with epilepsy diagnosis, age at onset or duration of the epilepsy, EEG or MRI features. The titration schedule of LEV appeared not to be relevant.. LEV therapy was well tolerated in patients with epilepsy and LD and the main problems were related to aggressive behaviour. The titration schedule of LEV was not relevant and a subgroup of patients appeared to be biologically more vulnerable.

Topics: Adult; Analysis of Variance; Anticonvulsants; Behavioral Symptoms; Chi-Square Distribution; Epilepsy; Female; Humans; Learning Disabilities; Levetiracetam; Male; Piracetam; Prevalence; Regression Analysis

The purpose was to evaluate the effects of levetiracetam (LEV) in routine therapy in learning disabled patients with therapy-resistant epilepsy.. In an open observational add-on study design, 46 patients (residents of the Bethel Epilepsy Centre) with severe therapy-resistant epilepsy and different degrees of learning disabilities, who were treated with LEV between its introduction in Autumn 2000 and February 2002, were evaluated retrospectively. Information on monthly seizure frequencies, seizure severity and psychiatric status was extracted from the current patient case records. A 3 months baseline and a 3 months LEV treatment period (after 3 months of titration) were compared. Responders were defined as having a 50% reduction in seizure frequency and being evaluated as good or very good in an ad hoc global clinical efficacy scale. When only one criterion was positive, a careful individual decision was made based on the impact on the patients' daily activities.. The responder rate was 41.3% (34.8 for 50% seizure reduction). It was higher in focal and multifocal epilepsy as compared to symptomatic generalised epilepsy/Lennox Gastaut Syndrome (P<0.05). Antiepileptic response occurred in doses between 500 and 4000 mg/day. Changes in seizure severity were rare. Nine patients experienced positive psychotropic effects (mostly improved vigilance and mood); six of these patients had antiepileptic effects as well. Twelve patients had adverse effects, mostly mild; in three cases, however, more severe effects led to discontinuation.. LEV is an effective and generally well-tolerated drug for this patient group, especially in focal and multifocal epilepsy.

Topics: Adolescent; Adult; Aged; Epilepsy; Female; Humans; Learning Disabilities; Levetiracetam; Male; Middle Aged; Piracetam; Retrospective Studies

Levetiracetam is a new anticonvulsant (AED) with a novel mechanism of action. Although it is generally well tolerated with a good cognitive profile, irritability and hostility have been reported in some adults taking levetiracetam. Observations in children are limited; levetiracetam is not yet approved by the Food and Drug Administration for use in children.. In four young patients, acute psychosis developed within days to months of initiation of levetiracetam for seizures.. A 5-year-old girl began having visual hallucinations of spiders in her room 14 days after starting levetiracetam. A 13-year-old boy began having auditory hallucinations, insomnia, and screaming behavior 3 months after initiation of levetiracetam. A 16-year-old girl became acutely agitated, hyperreligious, and had persecutory delusions within 7 days of starting levetiracetam. A 17-year-old girl had auditory hallucinations telling her to sing and yell after 30 days of taking the drug. All four children had dramatic improvement within days of either discontinuing or decreasing the dose of levetiracetam. The three adolescents had historical findings consistent with mild behavioral problems before initiating levetiracetam, and all four patients had prior cognitive deficits.. Reversible treatment-emergent psychosis associated with levetiracetam therapy was observed in four children and adolescents. Whether rapid initiation or prior neurobehavioral problems predispose to this side effect is not established.

Topics: Acute Disease; Adolescent; Anticonvulsants; Child, Preschool; Comorbidity; Drug Administration Schedule; Epilepsy; Female; Humans; Learning Disabilities; Levetiracetam; Male; Mental Disorders; Piracetam; Psychoses, Substance-Induced; Remission, Spontaneous