levetiracetam and Neurocysticercosis

The choice of antiepileptic drug (AED) in newly diagnosed neurocysticercosis (NCC) patients with epilepsy continues to be arbitrary. We compared efficacy and side effect profile of levetiracetam (LEV) and carbamazepine (CBZ) for the treatment of seizures in newly diagnosed patients with NCC.. This was an open-labeled randomized comparative monotherapy study including newly diagnosed drug naïve patients of NCC (n = 99) presenting with seizures who were randomized in 1:1 ratio using computed generated numbers. All patients were followed up for at least six months after start of treatment. The primary outcome measure was seizure control over six months following start of AEDs.. Fifteen (15.2%) patients [CBZ- 4(8.2%); LEV- 11(22%)] developed recurrence of seizures. A trend (p = 0.09) was found toward better control of seizures in CBZ compared to LEV. Two (4%) patients in LEV group and 17 (34.6%) patients in CBZ group developed drug-related minor side effects (p < 0.0001). Three patients in CBZ group needed discontinuation of therapy due to skin rash. Eleven patients who relapsed while on LEV did not have any recurrence of seizures after switching over to CBZ. Out of 3 patients who relapsed while receiving CBZ and were changed to LEV, two developed seizures during follow-up.. CBZ and LEV could be used as alternatives in newly diagnosed patients of NCC at the behest of minor side effects in the CBZ group.

Topics: Adolescent; Adult; Anticonvulsants; Carbamazepine; Child; Epilepsy; Female; Humans; Levetiracetam; Male; Middle Aged; Neurocysticercosis; Young Adult

In newly diagnosed neurocysticercosis (NCC) with seizures, the choice of anti-seizure medication (ASM) seems to be arbitrary due to a lack of comparative studies. Although oxcarbazepine (OXC) is often considered efficacious for focal seizures in NCC, due to adverse effects, newer ASMs like levetiracetam (LCM) and lacosamide are also being explored.. This study was performed by case record review of children with newly diagnosed solitary viable parenchymal NCC aged 4-18years who received lacosamide and OXC at least for 12 weeks between August 2019 and April 2021, from a prospective registry of a tertiary care teaching hospital in north India. Seizure control, electroencephalographic abnormalities, resolution of inflammatory granulomas and adverse effects were compared between two arms at 12 and 24 weeks.. Total 31 (8.3 ± 4.7 years, 19 boys) and 72 (8.6 ± 4.2 years, 43 boys) completed at least 12 weeks follow-up in LCM and OXC groups, out of which 2 and 51 completed at least 24 weeks follow-up in LCM and OXC groups, respectively. The occurrence of breakthrough seizure was comparable in both arms at 12 and 24 weeks (1/31 and 2/22 in lacosamide group vs. 2/72 and 4/51 in OXC group, p = 0.66 and 0.59, respectively). Patients receiving OXC had more frequent treatment-emergent adverse events (p = 0.0001) and four patients required discontinuation due to severe adverse events (SAEs), while none in the lacosamide group had SAEs.. Lacosamide appears to be efficacious and safe for achieving seizure freedom in patients with solitary viable parenchymal neurocysticercosis.

Topics: Anticonvulsants; Child; Epilepsies, Partial; Female; Humans; Lacosamide; Levetiracetam; Male; Neurocysticercosis; Oxcarbazepine; Seizures; Treatment Outcome

Topics: Anticonvulsants; Carbamazepine; Humans; Levetiracetam; Neurocysticercosis

Topics: Adult; Anticonvulsants; Blood Chemical Analysis; Brain; Consciousness Disorders; Diagnosis, Differential; Electroencephalography; Humans; Immunoblotting; Levetiracetam; Magnetic Resonance Imaging; Male; Neurocysticercosis; Parasitic Diseases; Seizures; Tomography, X-Ray Computed

Topics: Adolescent; Albendazole; Anthelmintics; Anticonvulsants; Brain; Brain Diseases; Emigrants and Immigrants; Epilepsy; Hispanic or Latino; Humans; Levetiracetam; Magnetic Resonance Imaging; Male; Mutism; Neurocysticercosis

Epilepsia partialis continua (EPC) of abdominal muscles is a rare entity with variable clinical localization and aetiology. A 25-year-old man presented with sudden onset of intermittent focal myoclonic movements involving the abdominal muscles on the right side exclusively, lasting from 20 minutes to an hour. Brain MRI revealed a ring-enhancing lesion, suggestive of cysticercal granuloma over the left precentral gyrus. The patient fulfilled the revised diagnostic criteria for definitive diagnosis of neurocysticercosis. EEG did not show focal abnormalities during the events. Episodes of EPC were controlled with difficulty using 600 mg oxcarbazepine, 200 mg lacosamide, and 2,000 mg levetiracetam. The patient received antiparasitic therapy with albendazole (15 mg/kg for two weeks) and oral dexamethasone (0.1 mg/kg) for two weeks which was then tapered. The involvement of the primary motor cortex during ictal propagation may account for this curious phenomenon. This is the first report of abdominal EPC in a patient with inflammatory granuloma as a result of neurocysticercosis.

Topics: Abdomen; Abdominal Muscles; Adult; Electroencephalography; Epilepsia Partialis Continua; Humans; Levetiracetam; Magnetic Resonance Imaging; Male; Motor Cortex; Neurocysticercosis

Qatar is a small country on the Eastern coast of the Arabian Peninsula. Its population is a unique mixture of native citizens and immigrants. We aimed to describe the features of epilepsy in Qatar as such information is virtually lacking from the current literature.. We summarized information retrospectively collected from 468 patients with epilepsy seen through the national health system adult neurology clinic.. Epilepsy was classified as focal in 65.5% of the cases and generalized in 23%. Common causes of epilepsy were as follows: stroke (9%), hippocampal sclerosis (7%), infections (6%), and trauma (6%). Sixty-six percent of patients were receiving a single antiepileptic drug, with levetiracetam being the most frequently prescribed drug (41% of subjects). When the patients were divided by geographical background, remote infections caused the epilepsy in 15% of Asian patients (with neurocysticercosis accounting for 10%) but only in 1% of Qatari and 3% of Middle East/North African subjects (with no reported neurocysticercosis) (p<0.001). Cerebrovascular and neurodegenerative etiologies were the most prominent in Qataris, accounting for 14% (p=0.005) and 4% (p=0.03) of cases, respectively. The choice of antiepileptic drugs varied also according to the regional background, but the seizure freedom rate did not, averaging at 54% on the last clinic visit.. To our knowledge, this is the first detailed information about epilepsy in Qatar. The geographical origin of patients adds to the heterogeneity of this disorder. Neurocysticercosis should be in the etiological differential diagnosis of epilepsy in patients coming from Southeast Asian countries, despite the fact that it is not endemic to Qatar. The choice of antiepileptic drugs is influenced by the availability of individual agents in the patients' native countries but had no bearing on the final seizure outcome.

Topics: Adult; Anticonvulsants; Diagnosis, Differential; Epilepsy; Female; Humans; Levetiracetam; Male; Middle Aged; Neurocysticercosis; Piracetam; Qatar; Retrospective Studies; Treatment Outcome; Young Adult

Topics: Adult; Albendazole; Animals; Anti-Inflammatory Agents; Anticonvulsants; Antiparasitic Agents; Developing Countries; Diagnosis, Differential; Emigration and Immigration; Enzyme-Linked Immunosorbent Assay; Humans; Immunoblotting; Levetiracetam; Magnetic Resonance Imaging; Male; Muscle Weakness; Nepal; Neurocysticercosis; Piracetam; Prednisolone; Seizures; Spinal Puncture; Taenia solium; Tremor; United Kingdom

We describe the first detailed histological description of an excised calcified Taenia solium granuloma from a patient who developed recurrent seizures associated with perilesional edema surrounding a calcified cysticercus (PEC). The capsule, around a degenerated cysticercus, contained marked mononuclear infiltrates that extended to adjacent brain, which showed marked astrocytosis, microgliosis, and inflammatory perivascular infiltrates. The presence of large numbers of mononuclear cells supports an inflammatory cause of PEC. Immunosuppression or anti-inflammatory measures may be able to treat and prevent PEC and recurrent seizures.

Topics: Albendazole; Animals; Anthelmintics; Anticonvulsants; Calcinosis; Edema; Granuloma; Humans; Levetiracetam; Male; Neurocysticercosis; Piracetam; Seizures; Taenia solium; Valproic Acid; Young Adult

Topics: Adult; Anticonvulsants; Brain; Epilepsy; Humans; Levetiracetam; Liver; Liver Failure, Acute; Liver Function Tests; Liver Transplantation; Male; Neurocysticercosis; Phenytoin; Piracetam; Treatment Outcome

In the treatment of seizures and epilepsy associated with central nervous system (CNS) infections, drug-drug interactions may significantly and unexpectedly impact outcome not only of epilepsy but also of the infectious disorders in both emergent and chronic care situations. A case is described in whom, the administration of the antimicrobial agent, meropenem presumably reduced serum valproate concentrations resulting in impaired seizure control. Other situations are reviewed in which interactions between antiepileptic drugs (AEDs) and antimicrobial agents may be of clinical significance. These include: (1) seizure management in individuals with neurocysticercosis, (2) management of seizures in patients with lobar tuberculomas, (3) management of seizures due to cerebral abscess, and (4) management of seizures in HIV-seropositive individuals.

Topics: Aged; Anti-Infective Agents; Anticonvulsants; Brain Abscess; Drug Interactions; Epilepsy; Female; Heart Block; HIV Infections; Humans; Levetiracetam; Neurocysticercosis; Piracetam; Valproic Acid