levetiracetam has been researched along with Mental-Disorders* in 31 studies
4 review(s) available for levetiracetam and Mental-Disorders
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Pyridoxine supplementation for levetiracetam-related neuropsychiatric adverse events: A systematic review.
Among people with epilepsy, levetiracetam (LEV) can cause neuropsychiatric adverse events (NPAEs) that impact negatively on quality of life. It has been suggested that pyridoxine can ameliorate LEV-related NPAEs. We conducted a systematic review of studies on the use of pyridoxine supplementation to relieve NPAEs associated with LEV therapy.. The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE, Scholar, Cochrane-CENTRAL (2000-2019), and EThOS platform were searched for studies on the use of pyridoxine in patients with LEV-related NPAEs. Proportions of patients reported to benefit from pyridoxine supplementation were tabulated, and a random-effect model meta-analysis was conducted.. Eleven retrospective studies/case reports and one randomized prospective study, mostly including pediatric populations, were identified. Retrospective studies, which were rated as low quality due to failure to control for bias, reported an overall improvement of NPAEs after pyridoxine supplementation in 72.5% (108/149) of patients. The proportion of patients showing improvement in a pooled analysis of the four largest retrospective studies (n = 134) was 72.1% (95% confidence interval (CI) 47.1-88.3), although there was high heterogeneity across studies (I. This systematic review suggests that pyridoxine might be of benefit in relieving LEV-related NPAEs. However, the quality of the evidence is poor, and better-designed prospective studies that include quantitative as well as qualitative data are needed to define the role of pyridoxine in the management of LEV-related NPAEs. Topics: Anticonvulsants; Diagnostic Tests, Routine; Dietary Supplements; Drug Therapy, Combination; Epilepsy; Humans; Levetiracetam; Mental Disorders; Prospective Studies; Pyridoxine; Quality of Life; Retrospective Studies; Vitamin B Complex | 2020 |
Safety of Levetiracetam in Paediatrics: A Systematic Review.
To identify adverse events (AEs) associated with Levetiracetam (LEV) in children.. Databases EMBASE (1974-February 2015) and Medline (1946-February 2015) were searched for articles in which paediatric patients (≤18 years) received LEV treatment for epilepsy. All studies with reports on safety were included. Studies involving adults, mixed age population (i.e. children and adults) in which the paediatric subpopulation was not sufficiently described, were excluded. A meta-analysis of the RCTs was carried out and association between the commonly reported AEs or treatment discontinuation and the type of regimen (polytherapy or monotherapy) was determined using Chi2 analysis.. Sixty seven articles involving 3,174 paediatric patients were identified. A total of 1,913 AEs were reported across studies. The most common AEs were behavioural problems and somnolence, which accounted for 10.9% and 8.4% of all AEs in prospective studies. 21 prospective studies involving 1120 children stated the number of children experiencing AEs. 47% of these children experienced AEs. Significantly more children experienced AEs with polytherapy (64%) than monotherapy (22%) (p<0.001). Levetiracetam was discontinued in 4.5% of all children on polytherapy and 0.9% on monotherapy (p<0.001), the majority were due to behavioural problems.. Behavioural problems and somnolence were the most prevalent adverse events to LEV and the most common causes of treatment discontinuation. Children on polytherapy have a greater risk of adverse events than those receiving monotherapy. Topics: Adolescent; Anticonvulsants; Child; Disorders of Excessive Somnolence; Epilepsy; Humans; Levetiracetam; Mental Disorders; Outcome Assessment, Health Care; Piracetam; Randomized Controlled Trials as Topic | 2016 |
Levetiracetam for managing neurologic and psychiatric disorders.
The role of levetiracetam in different epileptic, nonepileptic, neurologic, and psychiatric disorders is discussed.. Levetiracetam, an antiepileptic drug (AED), was first approved as an adjunctive therapy for the treatment of partial epilepsy in adults. It is currently being used in the treatment of multiple seizure disorders, including generalized tonic-clonic; absence; myoclonic, especially juvenile myoclonic; Lennox-Gastaut syndrome; and refractory epilepsy in children and adults. Data are emerging on possible uses of levetiracetam outside the realm of epilepsy because of its unique mechanisms of action. There is preliminary evidence about the efficacy of levetiracetam in the treatment of different psychiatric disorders, including anxiety, panic, stress, mood and bipolar, autism, and Tourette's syndrome. The most serious adverse effects associated with levetiracetam use are behavioral in nature and might be more common in patients with a history of psychiatric and neurobehavioral problems.. Levetiracetam is an effective AED with potential benefits in other neurologic and psychiatric disorders. The benefit-risk ratio in an individual patient with a specific condition should be used to determine its optimal use. Levetiracetam's use in nonepileptic conditions is not recommended until more data become available from larger trials. Topics: Anticonvulsants; Humans; Levetiracetam; Mental Disorders; Nervous System Diseases; Piracetam | 2009 |
Levetiracetam safety profiles and tolerability in epilepsy patients.
This review discusses the safety and tolerability of levetiracetam, as presented by the available literature, with attention paid to special populations. In Phase II/III trials, the adverse effects occurring more commonly in the treatment groups versus the placebo group were; somnolence (14.8 versus 8.4%), asthenia (14.7 versus 9.1%), infection (primarily common cold) (13.4 versus 7.5%), and dizziness (8.8 versus 4.1%). Adverse events usually appear within the first month after treatment initiation, are not dose-dependent, are mostly mild-to-moderate, generally resolve without medication withdrawal, and are transient when the medication is stopped. No significant changes in haematology and chemistry profiles or weight occurred. Hypersensitivity reactions were rare and no idiosyncratic event has been reported. Open-label studies have added patient data with other epileptic syndromes and from a wider patient pool, such as children and patients with prior psychiatric history. These studies have supported initial safety findings, but have reported increased behavioural adverse events in children and patients with a history of prior behavioural problems. Levetiracetam is proving to be safe and well-tolerated. So far, it appears to have a favourable safety profile in special populations, such as children, the elderly, and patients with hepatic dysfunction. Preliminary data in pregnancy are promising, but more data are needed on the impact of levetiracetam on the developing fetus and pharmacokinetic alterations caused in pregnancy. Adjustments in dosing are required for decreases in renal clearance. Topics: Abnormalities, Drug-Induced; Adolescent; Adult; Age Factors; Aged; Animals; Anticonvulsants; Asthenia; Bone Density; Child; Child Behavior Disorders; Clinical Trials as Topic; Disorders of Excessive Somnolence; Dizziness; Drug Evaluation, Preclinical; Epilepsy; Female; Headache; Humans; Infections; Kidney Diseases; Levetiracetam; Liver Diseases; Male; Mental Disorders; Mice; Middle Aged; Patient Acceptance of Health Care; Piracetam; Pregnancy; Pregnancy Complications | 2004 |
3 trial(s) available for levetiracetam and Mental-Disorders
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Usefulness of perampanel with concomitant levetiracetam for patients with drug-resistant epilepsy.
The purpose was to evaluate the efficacy of treatment and the occurrence of aggression-related adverse events among children receiving perampanel (PER) with concomitant levetiracetam (LEV).. Patients were selected according to the following criteria: 1) between 12 and 18 years old; 2) seizures refractory to at least 2 first-line drugs; 3) at least 4 seizures a month before PER administration; and 4) at least 12 months of follow-up. Patients were subdivided into groups with and without LEV as concomitant treatment. PER was administered at a dose of 2 mg/day, increasing by 2 mg/day every 2 weeks up to 12 mg/day if seizures appeared. In comparison with the baseline seizure frequency, response to PER treatment was classified as follows: complete cessation (100% seizure control); response (≥50% reduction in seizures); and exacerbation (≥50% increase in seizures). Responders were identified as patients showing complete cessation or response.. The study group comprised 39 outpatients with a mean age of 13.7 years at enrollment. Responder status was seen in 13 of the 19 patients with LEV and 4 of the 20 patients without LEV. PER appeared significantly more effective in patients with LEV than in those without LEV (p = 0.0076). Seizure-free status was significantly more frequent among patients with LEV (47.4%) than among those without LEV (15.0% (p = 0.0407)). Aggression was present in 2 patients without LEV, but none with LEV.. The present study suggests the utility of PER with concomitant LEV for children with drug-resistant epilepsy. Topics: Adolescent; Aggression; Anticonvulsants; Child; Child, Preschool; Drug Resistant Epilepsy; Drug Therapy, Combination; Female; Humans; Levetiracetam; Male; Mental Disorders; Nitriles; Pyridones; Treatment Outcome | 2019 |
An open-label, prospective, exploratory study of patients with epilepsy switching from levetiracetam to brivaracetam.
We evaluated nonpsychotic behavioral adverse events (BAEs) in patients receiving levetiracetam (LEV) who switched to brivaracetam (BRV). Patients ≥16 years of age, receiving 2-3 antiepileptic drugs (AEDs), including LEV 1-3g/day, and experiencing BAEs within 16 weeks of LEV treatment initiation, enrolled in an open-label Phase 3b study (NCT01653262) comprising a ≤1-week screening period, an immediate switch from LEV to BRV 200mg/day (without titration), and a 12-week treatment period. The percentages of patients with investigator-assessed clinically meaningful reduction in BAEs, shift in maximum BAE intensity, and change in health-related quality of life (HRQoL) (Patient-Weighted Quality of Life in Epilepsy Inventory-Form 31 [QOLIE-31-P]) were assessed. Of 29 patients enrolled, 26 (89.7%) completed the study. At the end of the treatment period, 27/29 (93.1%) patients switched to BRV had clinically meaningful reductions in BAEs. Physicians reported a reduction in the maximum intensity of primary BAEs in 27/29 (93.1%) patients. Mean change from baseline to Week 12 in QOLIE-31-P total score was 12.1, indicating improved HRQoL. During the treatment period, 23/29 (79.3%) patients reported treatment-emergent adverse events (TEAEs). One patient reported a serious TEAE (suicidal ideation and suicide attempt). Two patients discontinued BRV because of TEAEs. Findings from this small study suggest that patients experiencing BAEs associated with LEV may benefit from switching to BRV. Topics: Adolescent; Adult; Anticonvulsants; Epilepsy; Female; Humans; Levetiracetam; Male; Mental Disorders; Middle Aged; Piracetam; Prospective Studies; Pyrrolidinones; Quality of Life; Suicidal Ideation; Suicide, Attempted; Treatment Outcome; Young Adult | 2015 |
Maintenance of improvement in health-related quality of life during long-term treatment with levetiracetam.
Health-related quality of life (HRQOL) of patients taking levetiracetam (LEV) was evaluated in long-term follow-up. Short-term assessments compared LEV and placebo add-on therapy in an 18-week clinical trial, with long-term follow-up for a mean of 4.1 years. The QOLIE-31 was expanded to assess distress associated with each domain, change, and priority of importance of each domain. Significant improvements were observed at short-term in patients starting with LEV (N=66), whereas patients initially randomized to placebo (N=35) were unchanged. Improvement observed in LEV starters remained stable long-term. Placebo starters reached the same level of improvement in HRQOL at long-term. Correlations between the QOLIE-31-P distress items and domain items indicated that distress was significantly lower when HRQOL was better (P<0.0001, all domains). At long-term, highest-priority QOLIE-31-P domains were Social Functioning, Cognitive Function, and Overall QOL. Thus, gains in HRQOL were maintained during long-term LEV treatment, whether LEV was initiated early or late. Patient distress and importance of domains are useful data in determining how treatments impact on HRQOL. Topics: Adolescent; Adult; Aged; Anticonvulsants; Cognition Disorders; Drug Administration Schedule; Epilepsy; Female; Follow-Up Studies; Health Status; Humans; Levetiracetam; Male; Mental Disorders; Middle Aged; Neuropsychological Tests; Piracetam; Quality of Life; Social Behavior; Surveys and Questionnaires | 2003 |
24 other study(ies) available for levetiracetam and Mental-Disorders
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[Psychiatric Symptoms of Patients With Epilepsy: Characteristics of Psychiatric Adverse Events by Novel Antiepileptic Medications].
Patients with epilepsy often show treatment-related psychiatric symptoms. Among the novel antiseizure medications (ASM), Perampanel (PER), Levetiracetam (LEV), and Topiramate (TPM) have been reported to have a relatively high frequency of psychiatric adverse events. However, these psychiatric symptoms are not identical; PER and LEV show adverse events of irritability and aggression, while TPM shows typical symptoms of depression and schizophrenia. It is important to understand the characteristics of these psychiatric adverse events to design appropriate treatment regimens for epileptic patients. (Received August 1, 2022; Accepted December 24, 2022; Published April 1, 2023). Topics: Anticonvulsants; Epilepsy; Humans; Levetiracetam; Mental Disorders; Topiramate | 2023 |
Psychiatric disorders of the combination of levetiracetam either with lacosamide or perampanel: a retrospective cohort study.
Background The number of patients with epilepsy receiving perampanel or lacosamide as an add-on treatment following levetiracetam treatment has increased. Although levetiracetam causes psychiatric disorders, it is unclear whether they occur with the combined use of these antiepileptic drugs. Objective To determine the frequency of psychiatric disorders in patients received lacosamide or perampanel in combination with levetiracetam. Setting A single-center retrospective cohort study. Method Patients who received levetiracetam + lacosamide or levetiracetam + perampanel were selected. Medical records from the start of combination therapy contained characteristics of patients and the incidence of psychiatric disorders. Main outcome measure The frequency of psychiatric disorders, the time to onset, dose reduction or discontinuation following psychiatric disorders, and the clinical course following disorder onset. Results Forty-four patients used levetiracetam + lacosamide and 50 used levetiracetam + perampanel. The incidence of psychiatric disorders was significantly lower (p < 0.001) with levetiracetam + lacosamide (6.8%) than with levetiracetam + perampanel (44%). The incidence of affect lability was significantly higher with levetiracetam + perampanel than with levetiracetam + lacosamide (p = 0.018). The time to the onset of psychiatric disorders was within 1 month of dose initiation or increase in one case (33.3%) with levetiracetam + lacosamide and 16 cases (72.7%) with levetiracetam + perampanel. There was no significant difference in clinical characteristics and antiepileptic drug dosages owing to the presence or absence of psychiatric disorders. Conclusion As the frequency of psychiatric disorders was higher with levetiracetam + perampanel therapy, levetiracetam + lacosamide may be preferable. These disorders tended to develop within 1 month of therapy and were not dose-dependent. Antiepileptic drugs should be cautiously prescribed to avoid psychiatric disorders. Topics: Anticonvulsants; Drug Therapy, Combination; Humans; Lacosamide; Levetiracetam; Mental Disorders; Nitriles; Pyridones; Retrospective Studies; Treatment Outcome | 2021 |
Treatment patterns in patients with a new diagnosis of epilepsy and psychiatric comorbidities.
The objective of this study was to describe antiepileptic drug (AED) treatment patterns in patients with epilepsy, with and without psychiatric comorbidities.. This was a retrospective claims-based cohort study using Truven Health MarketScan databases (Commercial and supplemental Medicare, calendar years 2012-2017; Medicaid, 2012-2016). Persons met epilepsy diagnostic criteria, had an index date (first epilepsy diagnosis) with a preceding 2-year baseline (<1 year for persons of 1 to <2 years of age; none for persons <1 year), and continuous medical and pharmacy enrolment without epilepsy/seizure diagnosis or AED prescription during baseline. Based on presence/absence of psychiatric diagnosis codes in the baseline period, persons were classified into two cohorts: with or without psychiatric comorbidities. Outcomes included percentage of treated persons (AED prescription), type, duration, and outcome of first-line AED treatment.. There were 18,062 persons in each cohort with and without psychiatric comorbidities, matched by age, sex, and insurance type, who met selection (or inclusion) criteria. More patients with psychiatric comorbidities were prescribed an AED after diagnosis (57.6% vs. 52.8%), and had at least two AEDs prescribed during follow-up (16.7% vs. 11.4%) than patients without psychiatric comorbidities. Most patients with and without psychiatric comorbidities prescribed AED monotherapy as first-line treatment (73.0% vs. 78.7%). Levetiracetam was the most common AED prescribed less frequently in patients with than without psychiatric comorbidities (40.8% vs. 56.7%). More patients with psychiatric comorbidities changed first-line AED treatment than patients without psychiatric comorbidities.. The presence of psychiatric comorbidities may impact treatment decisions in newly diagnosed persons with epilepsy to optimize patient outcomes. Topics: Adolescent; Adult; Anticonvulsants; Child, Preschool; Cohort Studies; Comorbidity; Epilepsy; Female; Humans; Levetiracetam; Longitudinal Studies; Male; Medicaid; Medicare; Mental Disorders; Middle Aged; Retrospective Studies; United States | 2019 |
Adjunctive brivaracetam in focal and generalized epilepsies: A single-center open-label prospective study in patients with psychiatric comorbidities and intellectual disability.
Clinical studies suggest that the antiepileptic drug (AED) brivaracetam (BRV) is associated with fewer behavioral and psychiatric adverse events (AEs) compared with levetiracetam (LEV) in treating epilepsy. There are, however, few comparative studies of treatment-emergent AEs between patients on BRV with preexisting psychiatric or behavioral comorbidities to those without. Our study compared longer-term tolerability over a 26-month period between these patient groups and assessed the overall efficacy of BRV as add-on therapy. Patients with intellectual disabilities in whom the prevalence of epilepsy is higher, are often excluded from randomized controlled trials, and our study further assessed comparative effectiveness between this patient group and those with normal range intellect. We collected prospective data on 134 patients prescribed add-on BRV for epilepsy at a tertiary UK center over a 26-month period. All patients had previously received LEV. Sixty-three patients were on LEV at the start of the data collection period. Levetiracetam was withdrawn and switched to BRV in 39 patients because of inefficacy and 24 patients because of behavioral or psychiatric side effects. Seventy-three patients (54%) had a preexisting psychiatric or behavioral disorder compared with 64 patients (46%) without. The retention rate at last follow-up [mean: 11 months (0.5-26 months)] was 60% in the psychiatric/behavioral disorders group versus 67% in those without (p = 0.68). Forty-one patients had diagnosed intellectual disabilities. The retention rate was 66% in this group versus 62% in patients without intellectual disabilities (p = 0.36). The commonest treatment-emergent AEs were somnolence (26%), aggression (23%), and depression (9%). There were similar frequencies reported for these specific events across the groups. The proportion with a 50% responder rate was 29% in patients with focal epilepsy and 47% in patients with generalized and combined focal and generalized epilepsies. However, fifteen patients (11%) reported increased seizure activity leading to withdrawal of treatment. This study showed evidence that BRV may be an effective adjunctive therapy in patients with drug-resistant focal or generalized epilepsies whose seizures have previously not responded or tolerated LEV therapy. We demonstrated a higher incidence of treatment-emergent AEs leading to lower retention rates compared with previous studies across all patient groups. There were, however, no signifi Topics: Adolescent; Adult; Aged; Anticonvulsants; Behavioral Symptoms; Comorbidity; Drug Therapy, Combination; Epilepsies, Partial; Epilepsy, Generalized; Female; Humans; Intellectual Disability; Levetiracetam; Male; Mental Disorders; Middle Aged; Prospective Studies; Pyrrolidinones; Treatment Outcome; Young Adult | 2019 |
Levetiracetam-Through a Psychiatric Prism.
Topics: Aggression; Akathisia, Drug-Induced; Anticonvulsants; Autism Spectrum Disorder; Child; Epilepsy; Humans; Levetiracetam; Male; Mental Disorders; Self-Injurious Behavior; Treatment Outcome | 2019 |
Brivaracetam in adults with drug-resistant epilepsy and psychiatric comorbidities.
This is a case series of 25 patients with drug-resistant epilepsy and psychiatric comorbidities who started on brivaracetam (BRV) at St George's University Hospitals and Frimley Health in London. Median BRV dose was 150 mg for a median follow-up period of 8 months. Twenty had focal epilepsy, four had generalized epilepsies, and one had unclassified epilepsy; 76% had mood disorders (either depression or bipolar disorder), 12% intellectual disabilities with autism spectrum disorder and challenging behavior, and 12% psychoses. Forty percent of patients presented at least 50% seizure reduction, but none of them became seizure-free. A total of 44% of patients discontinued BRV, 20% because of adverse events, 20% because of inefficacy, and 4% because of both. Depression was reported by 8%, aggressive behavior by 8%, while 4% reported both. A total of 91.6% had received levetiracetam (LEV) before, in whom LEV was discontinued because of psychiatric adverse events (PAEs) in half. Seventy-seven percent of patients who developed PAEs with LEV did not do so on BRV suggesting that BRV is better tolerated than LEV in complex patients with psychiatric comorbidities and that the synaptic vesicle glycoprotein 2A (SV2A) protein modulation is unlikely to be implicated in LEV-related PAEs. Topics: Adolescent; Adult; Aged; Anticonvulsants; Autism Spectrum Disorder; Comorbidity; Drug Resistant Epilepsy; Female; Follow-Up Studies; Humans; Levetiracetam; London; Male; Mental Disorders; Middle Aged; Pyrrolidinones; Retrospective Studies; Seizures; Young Adult | 2019 |
Cognitive, behavioural and sleep-related adverse effects on introduction of levetiracetam versus oxcarbazepine for epilepsy.
There is limited literature on cognitive, behaviour and sleep-related adverse effects of levetiracetam and oxcarbazepine among adult epilepsy patients, except for what is available from the initial efficacy trials. This study was initiated with the aim to evaluate the incidence and prevalence of various cognitive, behaviour and sleep-related adverse effects of levetiracetam versus oxcarbazepine among people with epilepsy.. The study was conducted in two parts: part A was a cross-sectional study, and part B was a longitudinal study. Trail making test A & B, digit symbol substitution test, Stroop colour and word test, controlled oral word association test and PGI memory scale, Neuropsychiatric Inventory, sleep log and ESS-I were used for assessment of cognitive, behaviour and sleep-related adverse effects.. In the cross-sectional as well as prospective study, no significant difference was observed in the cognitive performance of patients in levetiracetam and oxcarbazepine group in any of the cognitive assessment. Among 120 patients enrolled in the cross-sectional study, significantly higher number of patients in the levetiracetam group compared to the oxcarbazepine group,had agitation/aggression (20% vs10%, p = 0.047) and irritability (26.7% vs 3.3%, p = 0.007).Among 132 patients enrolled in the prospective study, significantly higher increase in the domain score of agitation/aggression (14.5% vs 1.6%, p = 0.028) and irritability (17.7% vs 1.6%, p = 0.018) was observed in the levetiracetam group compared to oxcarbazepine group. A significantly higher proportion of patients in the oxcarbazepine group had hypersomnolence (11.3% vs 1.6%, p = 0.026), as compared to the levetiracetam group.. On cross-sectional as well as on longitudinal assessment, nearly one-fifth of patients on levetiracetam have behaviour related adverse effects, with dose modification required for half among these. Nearly 11% of patients on oxcarbazepine reported sleep-related adverse effects (higher total sleep duration per 24 h). Topics: Adult; Anticonvulsants; Cognition Disorders; Cross-Sectional Studies; Epilepsy; Female; Humans; Levetiracetam; Longitudinal Studies; Male; Mental Disorders; Neuropsychological Tests; Oxcarbazepine; Psychiatric Status Rating Scales; Sleep Wake Disorders; Young Adult | 2019 |
Prediction Tools for Psychiatric Adverse Effects After Levetiracetam Prescription.
Levetiracetam is a commonly used antiepileptic drug, yet psychiatric adverse effects are common and may lead to treatment discontinuation.. To derive prediction models to estimate the risk of psychiatric adverse effects from levetiracetam use.. Retrospective open cohort study. All patients meeting the case definition for epilepsy after the Acceptable Mortality Reporting date in The Health Improvement Network (THIN) database based in the United Kingdom (inclusive January 1, 2000, to May 31, 2012) who received a first-ever prescription for levetiracetam were included. Of 11 194 182 patients registered in THIN, this study identified 7400 presumed incident cases (66.1 cases per 100 000 persons) over a maximum of 12 years' follow-up. The index date was when patients received their first prescription code for levetiracetam, and follow-up lasted 2 years or until an event, loss to follow-up, or censoring. The analyses were performed on April 22, 2018.. A presumed first-ever prescription for levetiracetam.. The outcome of interest was a Read code for any psychiatric sign, symptom, or disorder as reached through consensus by 2 authors. This study used regression techniques to derive 2 prediction models, one for the overall population and one for those without a history of a psychiatric sign, symptom, or disorder during the study period.. Among 1173 patients with epilepsy receiving levetiracetam, the overall median age was 39 (interquartile range, 25-56) years, and 590 (50.3%) were female. A total of 14.1% (165 of 1173) experienced a psychiatric symptom or disorder within 2 years of index prescription. The odds of reporting a psychiatric symptom were significantly elevated for women (odds ratio [OR], 1.41; 95% CI, 0.99-2.01; P = .05) and those with a preexposure history of higher social deprivation (OR, 1.15; 95% CI, 1.01-1.31; P = .03), depression (OR, 2.20; 95% CI, 1.49-3.24; P < .001), anxiety (OR, 1.74; 95% CI, 1.11-2.72; P = .02), or recreational drug use (OR, 2.02; 95% CI, 1.20-3.37; P = .008). The model performed well after stratified k = 5-fold cross-validation (area under the curve [AUC], 0.68; 95% CI, 0.58-0.79). There was a gradient in risk, with probabilities increasing from 8% for 0 risk factors to 11% to 17% for 1, 17% to 31% for 2, 30% to 42% for 3, and 49% when all risk factors were present. For those free of a preexposure psychiatric code, a second model performed comparably well after k = 5-fold cross-validation (AUC, 0.72; 95% CI, 0.54-0.90). Specificity was maximized using threshold cutoffs of 0.10 (full model) and 0.14 (second model); a score below these thresholds indicates safety of prescription.. This study derived 2 simple models that predict the risk of a psychiatric adverse effect from levetiracetam. These algorithms can be used to guide prescription in clinical practice. Topics: Adult; Anticonvulsants; Epilepsy; Female; Follow-Up Studies; Humans; Levetiracetam; Male; Mental Disorders; Middle Aged; Models, Statistical; Prognosis; Retrospective Studies; Risk Assessment; Young Adult | 2019 |
Antiepileptic Drug Treatment Patterns in Women of Childbearing Age With Epilepsy.
Limited population-based data are available on antiepileptic drug (AED) treatment patterns in women of childbearing age with epilepsy; the current population risk is not clear.. To examine the AED treatment patterns and identify differences in use of valproate sodium and topiramate by comorbidities among women of childbearing age with epilepsy.. A retrospective cohort study used a nationwide commercial database and supplemental Medicare as well as Medicaid insurance claims data to identify 46 767 women with epilepsy aged 15 to 44 years. The eligible study cohort was enrolled between January 1, 2009, and December 31, 2013. Data analysis was conducted from January 1, 2017, to February 22, 2018.. Cases required an International Classification of Diseases, Ninth Revision, Clinical Modification-coded epilepsy diagnosis with continuous medical and pharmacy enrollment. Incident cases required a baseline of 2 or more years without an epilepsy diagnosis or AED prescription before the index date. For both incident and prevalent cases, focal and generalized epilepsy cohorts were matched by age, payer type, and enrollment period and then compared.. Antiepileptic drug treatment pattern according to seizure type and comorbidities.. Of the 46 767 patients identified, there were 8003 incident cases (mean [SD] age, 27.3 [9.4] years) and 38 764 prevalent cases (mean [SD] age, 29.7 [9.0] years). Among 3219 women in the incident epilepsy group who received AEDs for 90 days or more, 3173 (98.6%) received monotherapy as first-line treatment; among 28 239 treated prevalent cases, 18 987 (67.2%) received monotherapy. In 3544 (44.3%) incident cases and 9480 (24.5%) prevalent cases, AED treatment was not documented during 180 days or more of follow-up after diagnosis. Valproate (incident: 35 [5.81%]; prevalent: 514 [13.1%]) and phenytoin (incident: 33 [5.48%]; prevalent: 178 [4.53%]) were more commonly used for generalized epilepsy and oxcarbazepine (incident: 53 [8.03%]; prevalent: 386 [9.89%]) was more often used for focal epilepsy. Levetiracetam (incident: focal, 267 [40.5%]; generalized, 271 [45.0%]; prevalent: focal, 794 [20.3%]; generalized, 871 [22.2%]), lamotrigine (incident: focal, 123 [18.6%]; generalized, 106 [17.6%]; prevalent: focal, 968 [24.8%]; generalized, 871 [22.2%]), and topiramate (incident: focal, 102 [15.5%]; generalized, 64 [10.6%]; prevalent: focal, 499 [12.8%]; generalized, 470 [12.0%]) were leading AEDs prescribed for both focal and generalized epilepsy. Valproate was more commonly prescribed for women with comorbid headache or migraine (incident: 53 of 1251 [4.2%]; prevalent: 839 of 8046 [10.4%]), mood disorder (incident: 63 of 860 [7.3%]; prevalent: 1110 of 6995 [15.9%]), and anxiety and dissociative disorders (incident: 57 of 881 [6.5%]; prevalent: 798 of 5912 [13.5%]). Topiramate was more likely prescribed for those with comorbid headache or migraine (incident: 335 of 1251 [26.8%]; prevalent: 2322 of 8046 [28.9%]).. Many women appear to be treated with valproate and topiramate despite known teratogenicity risks. Comorbidities may affect selecting certain AEDs despite their teratogenicity risks. Topics: Adolescent; Adult; Anticonvulsants; Anxiety Disorders; Comorbidity; Dissociative Disorders; Epilepsies, Partial; Epilepsy, Generalized; Female; Headache Disorders; Humans; Lamotrigine; Levetiracetam; Mental Disorders; Migraine Disorders; Mood Disorders; Oxcarbazepine; Phenytoin; Retrospective Studies; Risk; Teratogens; Topiramate; Valproic Acid; Young Adult | 2019 |
Synaptic vesicle protein 2A tumoral expression predicts levetiracetam adverse events.
The efficacy of levetiracetam (LEV) in controlling seizures in patients with brain tumor-related epilepsy (BTRE) depends on tumoral expression of synaptic vesicle protein 2A (SV2A). Although LEV is generally well tolerated, neuropsychiatric adverse events (NPAEs) might occur, limiting compliance and seizure control. We aimed to assess the influence of tumoral SV2A expression on the occurrence of LEV-related NPAEs in patients with glioma.. Specimens from patients enrolled in the multicenter COMPO study, with glioma and BTRE treated with LEV, undergoing neurosurgery were retrieved. Immunohistochemistry-based expression of SV2A in tumoral and peritumoral tissue was scored in a four-point scale from absent (score = 0) to strong (score = 3). Low immunoreactivity (IR) corresponded to scores < 2. Staining ratios (tumoral SV2A IR/peritumoral SV2A IR) were grouped into low (≤ 0.5) and high (> 0.5). NPAEs were assessed longitudinally with the Neuropsychiatry Inventory 12 test (NPI-12).. Overall, 18 patients were eligible for analysis. All received LEV monotherapy, with 67% developing NPAEs. Patients with NPAEs had significantly lower median SV2A intensity score compared to patients without NPAEs (score 1 vs 0, p = 0.025). Low staining ratio (≤ 0.5) associated with higher NPAE occurrence compared to SR > 0.5 (85.7% vs 0%, p < 0.01). A SR ≤ 0.5 predicted a consistent increase in risk of NPAEs (OR 45.0; 95% CI 1.8-1128; p = 0.02).. Our results suggest that SV2A expression in tumoral and peritumoral tissue correlates with the occurrence of LEV-related NPAEs. Thus, considering that SV2A expression also influences LEV effectiveness, SV2A staining might help in tailoring treatment to patients. Topics: Adult; Aged; Anticonvulsants; Biomarkers; Brain Neoplasms; Epilepsy; Female; Gene Expression; Humans; Levetiracetam; Male; Membrane Glycoproteins; Mental Disorders; Middle Aged; Nerve Tissue Proteins; Predictive Value of Tests; Prospective Studies | 2019 |
Eslicarbazepine acetate as a replacement for levetiracetam in people with epilepsy developing behavioral adverse events.
Psychiatric and behavioral side effects (PBSEs) are a major cause of antiepileptic drug (AED) withdrawal. Levetiracetam (LEV) is a recognized first-line AED with good seizure outcomes but recognized with PBSEs. Eslicarbazepine (ESL) is considered to function similarly to an active metabolite of the commonly used carbamazepine (CBZ). Carbamazepine is used as psychotropic medication to assist in various psychiatric illnesses such as mood disorders, aggression, and anxiety.. The aim was to evaluate the psychiatric profile of ESL in people who had LEV withdrawn due to PBSEs in routine clinical practice to see if ESL can be used as a possible alternative to LEV.. A retrospective observational review was conducted in two UK epilepsy centers looking at all cases exposed to ESL since its licensing in 2010. The ESL group was all patients with treatment-resistant epilepsy who developed intolerable PBSEs to LEV, subsequently trialed on ESL. The ESL group was matched to a group who tolerated LEV without intolerable PBSEs. Psychiatric disorders were identified from case notes. The Hamilton Depression Scale (HAM-D) was used to outcome change in mood. Clinical diagnoses of a mental disorder were compared between groups using the Fisher's exact test. Group differences in HAM-D scores were assessed using the independent samples t-test (alpha=0.05).. The total number of people with active epilepsy in the two centers was 2142 of whom 46 had been exposed to ESL. Twenty-six had previous exposure to LEV and had intolerable PBSEs who were matched to a person tolerating LEV. There was no statistical differences in the two groups for mental disorders including mood as measured by HAM-D (Chi-square test: p=0.28).. The ESL was well tolerated and did not produce significant PBSEs in those who had PBSEs with LEV leading to withdrawal of the drug. Though numbers were small, the findings suggest that ESL could be a treatment option in those who develop PBSEs with LEV and possibly other AEDs. Topics: Adult; Anticonvulsants; Dibenzazepines; Drug Substitution; Drug-Related Side Effects and Adverse Reactions; Epilepsy; Female; Humans; Levetiracetam; Male; Mental Disorders; Middle Aged; Psychiatric Status Rating Scales; Retrospective Studies; Seizures; Substance Withdrawal Syndrome; Treatment Outcome; Voltage-Gated Sodium Channel Blockers | 2018 |
Brain tumor location influences the onset of acute psychiatric adverse events of levetiracetam therapy: an observational study.
To explore possible correlations among brain lesion location, development of psychiatric symptoms and the use of antiepileptic drugs (AEDs) in a population of patients with brain tumor and epilepsy. The medical records of 283 patients with various types of brain tumor (161 M/122 F, mean age 64.9 years) were analysed retrospectively. Patients with grade III and IV glioma, previous history of epileptic seizures and/or psychiatric disorders were excluded. Psychiatric symptoms occurring after initiation of AED therapy were considered as treatment emergent psychiatric adverse events (TE-PAEs) if they fulfilled the following conditions: (1) onset within 4 weeks after the beginning of AED therapy; (2) disappearance on drug discontinuation; (3) absence of any other identified possible concurrent cause. The possible influence of the following variables were analysed: (a) AED drug and dose; (b) location and neuroradiologic features of the tumor, (c) location and type of EEG epileptic abnormalities, (d) tumor excision already or not yet performed; (e) initiation or not of radiotherapy. TE-PAEs occurred in 27 of the 175 AED-treated patients (15.4%). Multivariate analysis showed a significant association of TE-PAEs occurrence with location of the tumor in the frontal lobe (Odds ratio: 5.56; 95% confidence interval 1.95-15.82; p value: 0.005) and treatment with levetiracetam (Odds ratio: 3.61; 95% confidence interval 1.48-8.2; p value: 0.001). Drug-unrelated acute psychiatric symptoms were observed in 4 of the 108 AED-untreated patients (3.7%) and in 7 of the 175 AED-treated patients (4%). The results of the present study suggest that an AED alternative to levetiracetam should be chosen to treat epileptic seizures in patients with a brain tumor located in the frontal lobe to minimize the possible onset of TE-PAEs. Topics: Aged; Anticonvulsants; Brain Neoplasms; Cohort Studies; Electroencephalography; Epilepsy; Female; Humans; Levetiracetam; Male; Mental Disorders; Middle Aged; Piracetam; Psychiatric Status Rating Scales; ROC Curve | 2017 |
Psychiatric side effects and antiepileptic drugs: Observations from prospective audits.
Psychiatric comorbidities are common in people with epilepsy. A retrospective study of characteristics associated with withdrawal due to psychiatric side effects was undertaken in patients with treated epilepsy participating in prospective audits with new antiepileptic drugs (AEDs). A total of 1058 treated patients with uncontrolled seizures (942 focal-onset seizures, 116 generalized genetic epilepsies [GGEs]) participated in eight prospective, observational audits from 1996 to 2014. These patients were prescribed adjunctive topiramate (n=170), levetiracetam (n=220), pregabalin (n=135), zonisamide (n=203), lacosamide (n=160), eslicarbazepine acetate (n=52), retigabine (n=64), or perampanel (n=54). Doses were titrated according to efficacy and tolerability to optimize zeizure outcomes and reduce side effects. Psychiatric comorbidities were recorded prior to and after the addition of each AED. At baseline, patients with focal-onset seizures (189 of 942; 20.1%) were statistically more likely to have psychiatric diagnoses compared to patients with GGEs (14 of 116, 12.1%; p=0.039). Following adjunctive AED treatment, neuropsychiatric adverse effects led to AED withdrawal in 1.9-16.7% of patients. Patients with a pre-treatment psychiatric history (22 of 209; 10.5%) were statistically more likely to discontinue their new AED due to psychiatric issues compared to patients with no previous psychiatric diagnosis (50 of 849; 5.9%; p=0.017). Patients receiving sodium channel blocking AEDs (4 of 212, 1.9%) were statistically less likely to develop intolerable psychiatric problems, compared to those on AEDs possessing other mechanisms of action (68 of 846, 8.0%; p=0.012). Depression was the commonest problem, leading to discontinuation of AEDs in 2.8% (n=30) patients. Aggression was statistically more common in men (11 of 527, 2.1%) compared to women (1 of 531, 0.2%; p=0.004). Patients with learning disability (12 of 122, 9.8%; p=0.0015) were statistically less likely to have psychiatric issues prior to adjunctive AED treatment compared to other patients (208 of 936, 22.2%), but there were no statistically significant differences once the new AEDs were added (8 of 122 patients with learning disability, 6.6%; 64 of 936 other patients, 6.8%). Awareness of these issues may assist clinicians in avoiding, identifying and treating psychiatric comorbidities in people with epilepsy. Topics: Acetamides; Adolescent; Adult; Aged; Aged, 80 and over; Anticonvulsants; Dibenzazepines; Drug-Related Side Effects and Adverse Reactions; Epilepsy; Female; Fructose; Humans; Lacosamide; Levetiracetam; Male; Medical Audit; Mental Disorders; Middle Aged; Nitriles; Piracetam; Pregabalin; Prospective Studies; Pyridones; Retrospective Studies; Seizures; Sodium Channel Blockers; Topiramate; Young Adult | 2017 |
Serious and reversible levetiracetam-induced psychiatric symptoms after resection of frontal low-grade glioma: two case histories.
Levetiracetam may induce serious behavioral disturbances, especially after surgical resection of frontal lobe low-grade glioma. Two patients, treated with levetiracetam, developed serious psychiatric complications postoperatively which completely resolved after switching to valproate. We aim to create awareness for this serious but reversible adverse effect of levetiracetam in this specific patient category. Topics: Anticonvulsants; Brain Neoplasms; Craniotomy; Epilepsy; Frontal Lobe; Humans; Levetiracetam; Magnetic Resonance Imaging; Male; Mental Disorders; Middle Aged; Oligodendroglioma; Piracetam; Postoperative Complications; Valproic Acid | 2017 |
Pharmacological outcomes in juvenile myoclonic epilepsy: Support for sodium valproate.
Juvenile myoclonic epilepsy (JME) is one of the most frequently diagnosed of the idiopathic generalised epilepsy syndromes, but long term outcome data still remain sparse.. A retrospective audit was undertaken in 186 patients (male: n=78; female: n=108) diagnosed with JME at the Epilepsy Unit at the Western Infirmary in Glasgow, Scotland between July 1981 and July 2012. Median age at treatment start was 16 years (range 13-44), with median follow-up of 14 years (range 2-32).. Overall, 171 patients (92%) achieved remission with antiepileptic drug (AED) treatment (median 9.5 years; range 1-31). After discontinuing treatment in 28 patients, only 11 remained seizure-free off medication. Fifteen patients (8%) continued to have seizures despite having tried up to 8 AED regimens: (5 male, 10 female), 7 of whom had psychiatric comorbidities. AEDs most commonly prescribed included sodium valproate (VPA; n=142), lamotrigine (LTG; n=66) and levetiracetam (LEV; n=22). More male patients than female attained remission with their first or second AED schedule (88% versus 56%). More male patients (44%) received VPA than female (31%) overall. Fewer male patients than female received LTG (26% versus 74%) and LEV (22% versus 78%). Of the monotherapies, remission was achieved using VPA (n=74; 52%), LTG (n=21; 32%) and LEV (n=12, 55%). A total of 76 (25%) of AED schedules resulted in intolerable side-effects, including 29 with VPA, 12 with LTG and 4 with LEV.. Overall, JME showed a high rate of seizure freedom with AED treatment. VPA appeared to be the most effective AED. Women tended to have a worse outcome than men, since they were increasingly less likely to receive VPA. Patients with psychiatric comorbidities also had a poorer prognosis. Topics: Adolescent; Adult; Anticonvulsants; Child; Comorbidity; Drug Resistant Epilepsy; Female; Follow-Up Studies; Humans; Lamotrigine; Levetiracetam; Male; Mental Disorders; Myoclonic Epilepsy, Juvenile; Piracetam; Retrospective Studies; Sex Factors; Treatment Outcome; Triazines; Valproic Acid; Young Adult | 2016 |
A Man in His 40s With Headache, Lethargy, and Altered Mental Status.
A man in his 40s presented with 1 month of worsening confusion, fatigue, and headache. Results from laboratory analyses were notable for a complete white blood cell count of 17 000/μL (31% blast cells), a platelet count of 76 000/μL, and a hemoglobin level of 16.6 g/dL. Imaging studies revealed a large mixed-attenuation subdural collection in the right frontal region with prominent mass effect. The patient underwent an emergency neurosurgical procedure. The differential diagnosis, pathologic findings, and diagnosis are discussed. Topics: Adult; Antineoplastic Agents, Hormonal; Craniotomy; Dexamethasone; DNA Nucleotidylexotransferase; Headache; Humans; Lethargy; Leukemia; Leukocytes, Mononuclear; Levetiracetam; Magnetic Resonance Imaging; Male; Mental Disorders; Nootropic Agents; Piracetam; Tomography, X-Ray Computed | 2015 |
[Two cases of autoimmune encephalitis with antibodies to N-methyl-D-aspartate receptor in intensive care].
We report here two cases of autoimmune encephalitis associated with antibodies against the N-methyl-D-aspartate receptor. The primary cause was an ovarian teratoma in one case. The outcomes were good. The first case was a late diagnosis, despite a typical clinical presentation. The clinical presentation of this disease remains unknown, especially in the intensive care unit. The treatment was recently codified and transformed the prognosis of this encephalitis. The second case was early treated in the course of the disease, due to the experience related to the previous case. In case of unexplained acute or subacute encephalitis or psychiatric-like disorders without prior medical history, the determination of the level of expression of antibodies against the N-methyl-D-aspartate receptors and other antineuroreceptors antibodies can help to identify this diagnosis. The initial picture of the disease, its variability and the unawareness of the recent reports on this encephalitis may lead to a wrong diagnosis and inappropriate management. Topics: Adrenal Cortex Hormones; Adult; Anticonvulsants; Autoimmune Diseases of the Nervous System; Critical Care; Early Diagnosis; Electroencephalography; Female; Glasgow Coma Scale; Humans; Immunization, Passive; Levetiracetam; Limbic Encephalitis; Magnetic Resonance Imaging; Marijuana Smoking; Mental Disorders; Nervous System Diseases; Ovarian Neoplasms; Piracetam; Receptors, N-Methyl-D-Aspartate; Teratoma; Tomography, X-Ray Computed | 2012 |
Assessing adherence-based quality measures in epilepsy.
To examine the relationship of three alternative measures of adherence with seven negative outcomes associated with epilepsy for development of a quality measure in epilepsy.. Retrospective cohort analysis.. PharMetrics national claims database.. Patients in the PharMetrics database for the years 2004-08 taking antiepileptic drugs.. None.. For each definition of adherence, the odds ratios (ORs) comparing non-adherent with adherent groups were assessed for consistency and direction for the number of hospital admissions, emergency room (ER) visits, head injuries including traumatic brain injuries, falls, motor vehicle accidents (MVAs), fractures and a 'seizure' outcome defined as hospital admissions or ER visits with a primary diagnosis of epilepsy or convulsions.. The inclusion criteria were met by 31 635 individuals. In the multivariate analysis, the adherent group had lower odds of hospital admissions with ORs for the eight specifications ranging from 0.729 to 0.872 and ER visits where ORs for the eight specifications ranged from 0.750 to 0.893. The eight ORs for head injuries ranged from 0.647 to 0.888. For fractures, the ORs ranged from 0.407 to 0.841. Our proxy for seizure was inconsistently associated with adherence status.. All the adherence measures defined non-adherent groups that were associated with negative outcomes in epilepsy. Topics: Adolescent; Adult; Aged; Anticonvulsants; Carbamazepine; Cohort Studies; Epilepsy; Female; Follow-Up Studies; Hospitalization; Humans; Levetiracetam; Male; Medication Adherence; Mental Disorders; Middle Aged; Odds Ratio; Phenytoin; Piracetam; Quality Indicators, Health Care; Retrospective Studies; Treatment Outcome; Young Adult | 2012 |
Efficacy and tolerability of high oral doses of levetiracetam in children with epilepsy.
Despite the advent of new antiepileptic drugs, many children continue to have refractory seizures. We sought to determine whether oral LEV is helpful in seizure control and tolerable at doses higher than 60mg/kg/day in the pediatric outpatient population.. A retrospective chart review over a 1.5-year period was performed at the Columbia Comprehensive Epilepsy Center to identify children who were treated with levetiracetam doses titrated above the usual 40-60mg/kg/day. Data was collected on seizure semiology, epilepsy type, seizure frequency, concomitant antiepileptic drugs, and adverse effects.. Thirty-two children, ranging in age from 1 to 19 years, required high dose levetiracetam. The median dosage of levetiracetam was 146mg/kg/day (range, 70-275mg/kg/day), and the median maximum serum trough level was 43mcg/ml (range, 20-121mcg/ml). All but one patient were taking one or more other antiepileptic drugs. A more than 50% reduction in seizure frequency was observed in 14 children (44%), with 5 achieving seizure freedom (16%). No response to high dose levetiracetam was found in 14 children (44%), and worsening of seizure frequency occurred in 4 (12%). Adverse effects were observed in 4 patients (12%), and were behavioral.. Not only do some children tolerate high doses and serum levels of levetiracetam, but they may also benefit from them, suggesting that doses higher than 60mg/kg/day may be considered in children who partially respond to the lower doses. Topics: Administration, Oral; Adolescent; Age Factors; Anticonvulsants; Child; Child, Preschool; Dose-Response Relationship, Drug; Electroencephalography; Epilepsy; Female; Humans; Infant; Levetiracetam; Male; Mental Disorders; Piracetam; Retrospective Studies; Treatment Outcome; Young Adult | 2010 |
Levetiracetam in clinical practice: long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center.
For the treatment of patients with chronic refractory epilepsies, development of new antiepileptic drugs is crucial. Three regulatory trials have demonstrated that add-on levetiracetam is efficacious in patients with localization-related epilepsy. However, results from these highly controlled short-term clinical trials cannot simply be extrapolated to everyday clinical practice. Therefore, more information is needed about the long-term profile of a new antiepileptic drug in clinical practice.. We analyzed all patients who had been treated with levetiracetam in the Epilepsy Centre Kempenhaeghe from the introduction of the drug in early 2001 up to a final assessment point, at the end of 2003, using a medical information system.. In total, 301 patients were included. One hundred thirty-eight patients (45.8%) discontinued LEV treatment during the 24-month follow-up period. Reasons for discontinuation were lack of efficacy in 15.9% of patients, adverse events in 6.0% of patients, and a combination of lack of efficacy and adverse events in 16.3% of patients. By Kaplan-Meier survival analysis, the continuation rate was 65.6% after 1 year and 45.8% after 2 years. About 15% of patients in this highly refractory group had a 3-month remission, whereas 10% of patients became seizure-free for longer periods. The most frequently reported side effects at the time of discontinuation were mood disorders, tiredness, and sleepiness. Variables predicting (dis)continuation of levetiracetam treatment could not be identified.. Levetiracetam is a new antiepileptic drug that appears to be a useful add-on treatment in patients with refractory epilepsy. Its side effect profile is mild, with mood disorders being the most dominant adverse event. Topics: Adolescent; Adult; Aged; Anticonvulsants; Child; Child, Preschool; Drug Resistance; Drug Therapy, Combination; Epilepsy; Female; Follow-Up Studies; Humans; Infant; Levetiracetam; Male; Mental Disorders; Middle Aged; Piracetam; Referral and Consultation; Seizures; Survival Analysis | 2007 |
Juvenile myoclonic epilepsy: a benign disorder? Personality traits and psychiatric symptoms.
Since the clinical observations published by Janz in 1957, the presence of personality irregularities in patients with juvenile myoclonic epilepsy (JME) has been described repeatedly, but never quantified using standardized assessments. The aim of the present study was to investigate whether juveniles with a short history of JME exhibit psychopathological symptoms and/or personality irregularities.. We used standardized assessments, the Youth Self Report (YSR) and the Weinberger Adjustment Inventory (WAI).. Of 38 patients who fulfilled the study entry criteria, 25 agreed to participate and completed all surveys. On the YSR, our sample exhibited twice the amount of psychiatric symptoms than age-matched norms. Furthermore, psychopathological symptoms increased with duration of JME. According to WAI results, JME significantly affected self-restraint: patients with longer disease duration showed less self-control.. Adolescents with JME present not only with neurological abnormalities but also with significant psychopathology and personality irregularities. Our data suggest that psychological and behavioral changes are dynamic processes dependent on the progression of the disease. Topics: Adolescent; Adult; Anticonvulsants; Child; Ethosuximide; Female; Fructose; Humans; Lamotrigine; Levetiracetam; Male; Mental Disorders; Myoclonic Epilepsy, Juvenile; Personality; Personality Tests; Piracetam; Psychiatric Status Rating Scales; Surveys and Questionnaires; Topiramate; Triazines; Valproic Acid | 2007 |
Are psychiatric adverse events of antiepileptic drugs a unique entity? A study on topiramate and levetiracetam.
To investigate the hypothesis that some patients with epilepsy are generally prone to develop psychiatric adverse events (PAEs) during antiepileptic drug (AED) therapy irrespective of the mechanism of action of the drugs.. From a large case registry of patients prescribed topiramate (TPM) and levetiracetam (LEV), data of patients who had a trial with both drugs were analyzed. Demographic and clinical variables of those who developed PAEs with both drugs (group 1) were compared with those who did not (group 2). Subsequently, from the whole case registry, psychopathological features, demographic, and clinical variables of patients developing PAEs with TPM were compared with those of patients developing PAEs with LEV.. The case registry included over 800 patients. Among 108 patients having a trial with both drugs, we identified 9 patients in group 1 and 71 in group 2. Previous psychiatric history, family psychiatric history and history of febrile convulsions showed to be significant clinical correlates. Comparing patients who developed PAEs with LEV with those who developed PAEs with TPM, there were no differences in epilepsy related variables. Well-defined DSM-IV disorders were more frequent with TPM than with LEV. Seizure freedom was associated with psychosis.. This study suggests that a subgroup of patients is generally prone to develop PAEs during AED therapy, despite different pharmacological properties of the AEDs. A particular clinical profile and relevant variables have been identified. Topics: Adult; Anticonvulsants; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Epilepsy; Female; Fructose; Humans; Levetiracetam; Male; Mental Disorders; Netherlands; Piracetam; Psychiatric Status Rating Scales; Psychoses, Substance-Induced; Registries; Retrospective Studies; Seizures, Febrile; Topiramate | 2007 |
Levetiracetam in adult patients with and without learning disability: focus on behavioral adverse effects.
Optimal antiepileptic drug treatment in patients with learning disability (LD) represents a particular challenge. These patients are often unable to report toxicity, and side effects may manifest as behavioral problems. The aim of this open study was to compare efficacy and tolerability of levetiracetam (LEV) in patients with LD and those without LD. One hundred eighty-four consecutive adult patients who received LEV were followed for an average of 8.1 months. Fifty-six patients (30%) had LD. Thirty-nine percent of patients with refractory epilepsy (37% with and 40% without LD) had > 50% seizure reduction. Significantly more behavioral side effects (23% vs 10%) and a tendency toward less reported somatic central nervous side effects were found in the LD group. We conclude that LEV is equally effective and well tolerated in both patients with LD and patients without LD. However, behavioral problems are more frequent in patients with LD, whereas the tendency toward seizure increase is not enhanced. Topics: Adolescent; Adult; Aged; Anticonvulsants; Dose-Response Relationship, Drug; Drug Resistance; Drug Therapy, Combination; Epilepsies, Partial; Epilepsy, Generalized; Female; Humans; Intellectual Disability; Levetiracetam; Male; Mental Disorders; Middle Aged; Myoclonic Epilepsy, Juvenile; Piracetam; Retrospective Studies | 2004 |
Levetiracetam psychosis in children with epilepsy.
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 | 2001 |