levetiracetam and Thrombocytopenia

BACKGROUND Phenytoin is an antiepileptic drug that is usually prescribed as a prevention treatment for tonic-clonic seizures or partial seizures, and as a prophylaxis for the neurosurgical related seizures. Phenytoin administration has several drawbacks; one drawback phenytoin-induced thrombocytopenia, which is a rare and significant adverse event. We report a rare adverse event after phenytoin prophylaxis therapy after a brain tumor debulking surgery, which resulted in severe unpredicted thrombocytopenia. CASE REPORT A 40-year-old male with no known health problems started to have an on/off headaches and loss of memory. Clinical investigations revealed a right frontal brain lesion. On the first day of admission, the patient was managed on neurosurgical seizure prophylaxis therapy of 100 mg intravenous phenytoin every 8 hours and 4 mg oral dexamethasone every 6 hours. On the fifth day of hospital admission, the patient underwent tumor debulking surgery. Twenty-four hours post-surgery, the patient's platelet level dropped to 26×10⁹/L. Severe thrombocytopenia was managed first by transfusion of 17 units of platelets and by cessation of intravenous phenytoin plus the starting of 500 mg levetiracetam orally twice daily. Further management included infusion of 34 grams (0.4 g/kg) intravenous immunoglobulin (IVIG) over 5 days. Five days later, the patient gradually recovered with a platelet count of 239×10⁹/L. CONCLUSIONS Phenytoin-induced thrombocytopenia is considered a rare event, but it has life-threatening consequences. The first and cornerstone management of this event is the cessation of phenytoin, followed by consideration of appropriate management based on the level of thrombocytopenia severity, and avoiding concomitant therapy of phenytoin and the use of dexamethasone as neurosurgical-related seizure prophylaxis.

Topics: Adult; Anticonvulsants; Brain Neoplasms; Cytoreduction Surgical Procedures; Humans; Immunoglobulins, Intravenous; Levetiracetam; Male; Phenytoin; Postoperative Complications; Thrombocytopenia

Levetiracetam has broad-spectrum activity in epilepsy. In contrast to phenytoin, levetiracetam has an ideal pharmacokinetic profile without any severe haemodynamic side effects and therefore intravenous loading of levetiracetam is commonly used in adult patients with status epilepticus, especially those who have medical problems. However, levetiracetam-induced serious adverse effects, such as thrombocytopenia and pancytopenia, have been reported in the literature. Here, we describe a case of status epilepticus after cardiac arrest treated with levetiracetam in which severe thrombocytopenia developed and was successfully managed by discontinuation of levetiracetam. Our report aims to increase awareness of this rare cause of thrombocytopenia among clinicians and provide a review of the literature.

Topics: Aged; Anticonvulsants; Female; Humans; Levetiracetam; Piracetam; Status Epilepticus; Thrombocytopenia

Rare cases of levetiracetam-induced thrombocytopenia have been reported in the literature. We report a case of glioblastoma multiforme and partial epilepsy treated with levetiracetam with subsequent development of thrombocytopenia. After ruling out all other possible causes of a decreased platelet count, we conclude that levetiracetam was the cause of this adverse event.

Topics: Anticonvulsants; Brain Neoplasms; Epilepsies, Partial; Female; Frontal Lobe; Glioblastoma; Humans; Levetiracetam; Middle Aged; Piracetam; Platelet Count; Thrombocytopenia; Treatment Outcome

Lately, few case reports have brought forth limited cases of levetiracetam (LEV)-induced thrombocytopenia. To estimate the burden of LEV-induced thrombocytopenia, we reviewed medical records of 758 patients aged 18 years or older who received LEV during their stay at the University Hospital from June 2005 to December 2008. In patients identified with thrombocytopenia, records were reviewed to establish a cause of thrombocytopenia and possible causal role of LEV. Of 758 patients, 29 patients were identified with thrombocytopenia while on LEV therapy. For 23 patients, an alternative cause for thrombocytopenia was established; 4 patients had preexisting thrombocytopenia without any appreciable change in platelet count after addition of LEV. One patient had limited data for identifying the cause of thrombocytopenia. A single patient had clear temporal co-relation and association of thrombocytopenia with LEV therapy. LEV-induced thrombocytopenia is a rare but reversible complication of LEV therapy. The mechanism remains unknown.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticonvulsants; Blood Platelets; Drug Therapy, Combination; Epilepsy, Generalized; Female; Humans; Levetiracetam; Male; Middle Aged; Piracetam; Retrospective Studies; Thrombocytopenia

Levetiracetam is one of the newer anti-epileptic medications, which is now widely used in the treatment of childhood epilepsy. Thrombocytopenia is not a well-known adverse effect of this medication. There have only been two adult case reports describing this feature as an adverse effect of levetiracetam. We describe this feature in a child. A six and half-year-old boy developed symptomatic epilepsy secondary to cerebral venous sinus thrombosis. He was treated with levetiracetam. He made a good recovery from his primary illness, but five weeks after he started taking levetiracetam, he presented with thrombocytopenia requiring platelet transfusion. Extensive investigations for known causes of thrombocytopenia were negative. Withdrawal of levetiracetam led to the resolution of thrombocytopenia. Levetiracetam-induced thrombocytopenia is a rare, but significant adverse effect.

Topics: Anticonvulsants; Child; Epilepsy; Humans; Levetiracetam; Male; Piracetam; Sinus Thrombosis, Intracranial; Thrombocytopenia

A 64-year-old patient with symptomatic epilepsy developed thrombocytopenia during treatment with levetiracetam (LEV). As no other medical reason could be evaluated, a medication side effect was postulated. The only new drugs were valproic acid (since 3 weeks) and levetiracetam (since 3 days). After valproic acid medication was ended, thrombocytopenia did not improve and even worsened further. Finally levetiracetam administration was ended and trombocytopenia resolved rapidly and completely within few days.

Topics: Anticonvulsants; Epilepsy, Complex Partial; Female; Humans; Levetiracetam; Middle Aged; Piracetam; Thrombocytopenia

Mitochondrial cytopathy is a multisystemic disease that requires different pharmacological and specialist approaches; although most therapies are usually of scarce effectiveness. We describe a clinical management of a very young girl with Pearson's syndrome that developed the symptoms of Kearns-Sayre syndrome. Many of symptoms were temporarily improved by the replacement therapy with hydrocortisone introduced to treat the partial adrenal insufficiency. During her life, she showed an ample clinical spectrum of symptoms because of multiple organs involvements: firstly bone marrow and, thereafter, brain, retina, inner ear, and kidney. Partial adrenal insufficiency, rarely described in mitochondrial disorders, was a distinctive characteristic of this case. When our patient was treated with hydrocortisone, in addition to ubiquinone and carnitine, the episodes of decompensation regressed and an improvement of the adrenal insufficiency, but only temporary reversion of the weakness of muscle, ophthalmoplegia and of the fatigue, were testified. Nevertheless, after a brief period of recovery, she developed the de Toni-Debré-Fanconi syndrome and the reappearance of the neurological symptoms.

Topics: Acidosis, Lactic; Bone Marrow Diseases; Calcium; Child, Preschool; Disease Progression; DNA, Mitochondrial; Ergocalciferols; Fanconi Syndrome; Female; Humans; Kearns-Sayre Syndrome; Levetiracetam; Neutropenia; Nootropic Agents; Pancreas, Exocrine; Pancreatic Diseases; Piracetam; Sodium Bicarbonate; Thrombocytopenia

Topics: Anticonvulsants; Epilepsy; Humans; Levetiracetam; Male; Middle Aged; Piracetam; Sweden; Thrombocytopenia