levetiracetam and Multiple-Sclerosis--Relapsing-Remitting

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder mediated by NMDAR antibodies, typically manifesting as behavioral complaints, psychosis, seizures, movement disorders, hypoventilation, and autonomic dysfunction. In recent years, the predisposing factors and pathophysiological mechanisms of anti-NMDAR encephalitis have been tried to be clarified. It has been recognized that an overlap may be observed between anti-NMDAR encephalitis and inflammatory demyelinating disease. However, anti-NMDAR encephalitis is rarely associated with multiple sclerosis. Here, we describe a Chinese female patient diagnosed with relapsing remitting multiple sclerosis who developed anti-NMDAR encephalitis. Further, we discuss the previously reported literature.

Topics: Adult; Anti-Inflammatory Agents; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Anticonvulsants; Antipsychotic Agents; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Levetiracetam; Methylprednisolone; Multiple Sclerosis, Relapsing-Remitting; Olanzapine; Prednisolone

Multiple sclerosis (MS) intention tremor is a disabling symptom, which is difficult to treat.. To investigate the effects of levetiracetam, an antiepileptic drug, on tremor severity and related functionality in MS.. A randomized, double-blind, placebo-controlled, cross-over study examined the effects of 6 weeks of oral levetiracetam administration (starting dose=250 mg/day, maximal dose=2000 mg/day) in 18 MS patients with disabling intention tremor. Primary outcome was Fahn's Tremor Rating Scale (FTRS) A&B. Secondary outcome measures were the nine-hole peg test, patient's opinion rated with the visual analog scale, FTRS C, and an activities of daily life questionnaire and validated tremor indexes derived during the performance of a digitized spiral drawing task and a wrist step-tracking task. Repeated measures analysis of variance and Friedman tests were applied.. In all, 14 patients completed the trial. Maximal dose intake ranged from 1000 to most commonly 2000 mg, depending on patients' tolerance level. No significant effects of levetiracetam were found for any outcome measure. Further analyses on subgroups with different tremor severity showed no differential effects. Eight patients reported adverse events such as fatigue and stomach ache.. Levetiracetam intake of 2000 mg/day did not affect tremor severity or functionality in patients with MS.

Topics: Administration, Oral; Adult; Anticonvulsants; Cross-Over Studies; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Levetiracetam; Male; Middle Aged; Multiple Sclerosis, Chronic Progressive; Multiple Sclerosis, Relapsing-Remitting; Piracetam; Placebos; Severity of Illness Index; Treatment Outcome; Tremor

Paroxysmal ataxia and dysarthria (PAD) is a relatively rare symptom in Multiple Sclerosis patients. PAD involves transient dysfunction in control, coordination and initiation of speech and/or limb movements.. To describe the successful use of levetiracetam for the treatment of PAD.. Case report.. A 37-year-old woman with MS developed PAD approximately 3 months after a multifocal MS relapse. Brain MRI showed a lesion in the posterior aspect of the midbrain as well as in the right posterior internal capsule, both of which were adjacent to the red nucleus. Attack frequency was reduced after starting levetiracetam at a dose of 500mg twice daily, and attacks stopped completely once the dose was increased to 750mg twice daily.. Given its advantages (in terms of side effects, safety profile and ease of use compared to other anticonvulsants), we suggest that levetiracetam be considered for management of PAD, and perhaps for other paroxysmal MS symptoms as well.

Topics: Adult; Anticonvulsants; Brain; Dysarthria; Female; Humans; Levetiracetam; Magnetic Resonance Imaging; Multiple Sclerosis, Relapsing-Remitting; Piracetam; Video Recording