IV levetiracetam in the management of non-convulsive status epilepticus
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PRACTICAL PEARL
IV levetiracetam in the management of non-convulsive status epilepticus Muhammad U. Farooq Æ Bharath Naravetla Æ Arshad Majid Æ Rishi Gupta Æ Joseph J. Pysh Æ Mounzer Y. Kassab
Published online: 13 April 2007 Ó Humana Press Inc. 2007
Abstract Introduction Status epilepticus (SE) is a medical emergency requiring prompt treatment to try to limit mortality and improve outcome. So far, newer antiepileptic drugs (AED) have not assumed a noticeable role in the treatment of SE. This may be in part due to the lack of IV forms for the newer AEDs. The IV form of Levetiracetam (IV-LEV) has recently become available and has a potential role in the treatment of SE. Methods and results We report two cases of non-convulsive SE that responded favorably to IV-LEV. The first patient is an 83-year-old male with a history of complex partial seizure disorder who presented with impaired consciousness. The second patient is an 82-year-old male with history of old left middle cerebral artery ischemic infarction, who presented with confusion. Both patients were found to have a non-convulsive status epilepticus on electroencephalography (EEG) and treated with IV-LEV. In both cases, electrographic SE stopped with marked clinical improvement. Both patients tolerated the medication well and no significant side effects occurred. Conclusion IV-LEV may have a potential role in the treatment of non-convulsive status epileptics. Keywords Intravenous levetiracetam Non-convulsive status epilepticus
M. U. Farooq B. Naravetla A. Majid R. Gupta J. J. Pysh M. Y. Kassab (&) Department of Neurology and Ophthalmology, Michigan State University, 138 Service Road, A-217 Clinical Center, East Lansing, MI 48824, USA e-mail: [email protected] M. U. Farooq B. Naravetla A. Majid R. Gupta J. J. Pysh M. Y. Kassab Sparrow Healthcare System, Lansing, MI, USA
Introduction Fosphenytoin, valproic acid, and phenobarbital are available in intravenous forms and are used in the treatment of SE. So far, a new generation AED is not a common choice in the management of SE. This may be mainly due to the lack of an IV form of the newer AEDs. Levetiracetam (LEV) is approved as an adjunct therapy in the treatment of partial onset seizures in adults with epilepsy. IV-LEV has been recently introduced and may have a role in the management of SE [1–3] but little data exist on safety and efficacy.
Case reports First case: An 83-year-old male with a history of complex partial epilepsy (under control with a twice daily dose of 1,000 mg of oral LEV), transient ischemic attacks, strokes, and atrial fibrillation presented with a 12 h history of decreased level of responsiveness and confusion. He missed his regular LEV dose for the 3 days before presentation. He did not have any abnormal movements, stiffening, or incontinence. Blood tests including complete blood count and basic metabolic profile were normal. Computerized tomography of the brain showed mild to moderate atrophic and periventricular white matter changes without acute intracrania
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