Revital Sheinberg1, Eli Heyman2, Zahi Dagan3, Ilan Youngster1, Elkana Kohn4, Revital Gandelman-Marton5, Matitiahu Berkovitch6. 1. Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel. 2. Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel; Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Israel. 4. Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Israel. 5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Electroencephalography Laboratory, Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel. 6. Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Clinical Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Israel. Electronic address: mberkovitch@asaf.health.gov.il.
Abstract
BACKGROUND: Levetiracetam is used as adjunctive therapy in various types of seizures. Studies evaluating the effect of levetiracetam on children with refractory epilepsy are scarce. The aim of this study was to evaluate the correlation between serum concentration of levetiracetam and either efficacy or tolerability in children with refractory epilepsy, and to determine the value of levetiracetam blood level monitoring. METHODS: Medical records of 50 children with refractory epilepsy treated with levetiracetam and regularly followed at Assaf Harofeh Medical Center were retrospectively reviewed. Trough serum levetiracetam concentration was determined using high-performance liquid chromatography and correlated with the administered dose and clinical report. RESULTS: No correlation between levetiracetam serum levels and clinical efficacy, tolerability or administered dosage was found. The average dose of levetiracetam was 43.7 ± 20.0 (range 14-100) mg/kg/day and the average serum concentration was 16.0 ± 9.5 (range 2.5-38.5) μg/mL. Forty-five patients (95%) had more than a 50% reduction of seizure frequency, with 22 (44%) patients becoming seizure-free for at least 6 months. Adverse events related to levetiracetam were reported in 15 (30%) patients. No correlation between serum concentrations and adverse events was found. These results were not affected by gender, age, type of seizure, and other drugs. CONCLUSIONS: Determination of serum concentration is not needed in all children treated with levetiracetam. Serum concentrations may be valuable either in patients with refractory epilepsy for compliance evaluation or in patients with satisfactory control of seizures for determination of their therapeutic baseline.
BACKGROUND:Levetiracetam is used as adjunctive therapy in various types of seizures. Studies evaluating the effect of levetiracetam on children with refractory epilepsy are scarce. The aim of this study was to evaluate the correlation between serum concentration of levetiracetam and either efficacy or tolerability in children with refractory epilepsy, and to determine the value of levetiracetam blood level monitoring. METHODS: Medical records of 50 children with refractory epilepsy treated with levetiracetam and regularly followed at Assaf Harofeh Medical Center were retrospectively reviewed. Trough serum levetiracetam concentration was determined using high-performance liquid chromatography and correlated with the administered dose and clinical report. RESULTS: No correlation between levetiracetam serum levels and clinical efficacy, tolerability or administered dosage was found. The average dose of levetiracetam was 43.7 ± 20.0 (range 14-100) mg/kg/day and the average serum concentration was 16.0 ± 9.5 (range 2.5-38.5) μg/mL. Forty-five patients (95%) had more than a 50% reduction of seizure frequency, with 22 (44%) patients becoming seizure-free for at least 6 months. Adverse events related to levetiracetam were reported in 15 (30%) patients. No correlation between serum concentrations and adverse events was found. These results were not affected by gender, age, type of seizure, and other drugs. CONCLUSIONS: Determination of serum concentration is not needed in all children treated with levetiracetam. Serum concentrations may be valuable either in patients with refractory epilepsy for compliance evaluation or in patients with satisfactory control of seizures for determination of their therapeutic baseline.
Authors: Jennifer C Keene; Mark Wainwright; Lindsey A Morgan; Ulrike Mietzsch; Ndidi Musa; Xiuhua L Bozarth; Niranjana Natarajan Journal: J Pediatr Pharmacol Ther Date: 2022-03-21
Authors: Sandra R P Kriechbaumer; Konrad Jurina; Franziska Wielaender; Henning C Schenk; Tanja A Steinberg; Sven Reese; Gesine Buhmann; Stefanie Doerfelt; Heidrun Potschka; Andrea Fischer Journal: Front Vet Sci Date: 2022-07-06