levetiracetam and Muscle-Spasticity

Cramps and spasticity impair quality of life and function in patients with motor neuron diseases, and there are no proven treatments for these problems. We conducted a pilot trial to determine if treatment with levetiracetam was associated with a reduction in cramp severity, cramp frequency, tonic or phasic spasticity. We used an open-label repeated measures pilot trial of 20 patients, comparing cramp and spasticity scores over a 3-month baseline versus nine months on treatment. Cramp and spasticity scores were stable over a 3-month baseline. Shortly after starting levetiracetam, there was a significant reduction in cramp severity and frequency, which persisted for the duration of this year-long study. There was also a reduction in phasic but not tonic spasticity. Levetiracetam was well tolerated. Our results justify a placebo-controlled study of levetiracetam for treatment of cramps and spasticity in patients with motor neuron diseases, and suggest that this can be accomplished with a small number of subjects followed for a short time.

Topics: Adult; Aged; Anticonvulsants; Disease Progression; Humans; Levetiracetam; Middle Aged; Motor Neuron Disease; Muscle Cramp; Muscle Spasticity; Pilot Projects; Piracetam; Placebos; Randomized Controlled Trials as Topic

Topics: Adult; Anticonvulsants; Basal Ganglia Diseases; Brain; Calcinosis; Central Nervous System Cysts; Dystonia; Female; Gait Disorders, Neurologic; Humans; Infant, Newborn; Infant, Premature; Leukoencephalopathies; Levetiracetam; Magnetic Resonance Imaging; Muscle Spasticity; Neurologic Examination; Piracetam; Seizures; Spinal Puncture; Tomography, X-Ray Computed

This month's Spotlight on... focuses on the current clinical development of the antiepileptic drug levetiracetam for amyotrophic lateral sclerosis. We highlight the experimental rationale behind its progress into patient cohorts with regards to targeting three currently untreatable aspects of human amyotrophic lateral sclerosis: cramps, spasticity and disease progression.

Topics: Amyotrophic Lateral Sclerosis; Animals; Anticonvulsants; Clinical Trials as Topic; Humans; Levetiracetam; Muscle Cramp; Muscle Spasticity; Neuroprotective Agents; Piracetam

Topics: Female; GABA Agonists; Humans; Immunoglobulins, Intravenous; Levetiracetam; Middle Aged; Muscle Spasticity; Piracetam; Stiff-Person Syndrome; Valproic Acid

Spasticity is a common and debilitating symptom of multiple sclerosis (MS). Current treatments are effective, but may be difficult to tolerate for many patients.. To determine if levetiracetam, a second-generation antiepileptic drug, may be useful for the treatment of spasticity in MS.. A retrospective medical record review of patients attending the Multiple Sclerosis Program at the University of Texas, Southwestern Medical Center at Dallas was performed. A series of 12 patients who had been treated with levetiracetam for spasticity was identified. Most of the patients were female (10/11), and the mean age was 41.0 years. The main outcome measure was a change in Penn spasm score or modified Ashworth score. Both scores are measured on a scale of 0 to 4.. The Penn Spasm score (a measure of phasic spasticity) was decreased for all patients following treatment with levetiracetam. The mean +/- SD Penn Spasm score was 2.7 +/- 0.65 at baseline and decreased to 0.9 +/- 0.29 at follow-up. There was no change in modified Ashworth scores (a measure of tonic spasticity). Five patients reported adverse events; 1 patient discontinued treatment owing to an adverse event (edema). Three patients incidentally reported improvements in neuropathic pain.. Levetiracetam was effective for reducing phasic spasticity but not tonic spasticity in this 12-patient case series. The drug was well tolerated and therefore shows promise as a treatment for phasic spasticity. Large, well-controlled trials are needed to confirm these findings.

Topics: Adult; Anticonvulsants; Dose-Response Relationship, Drug; Female; Humans; Levetiracetam; Male; Middle Aged; Multiple Sclerosis; Muscle Spasticity; Piracetam; Retrospective Studies; Severity of Illness Index