Levetiracetam-induced seizure aggravation-case series and literature review

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy Pub Date : 2025-04-10 DOI:10.1016/j.seizure.2025.04.005

Tal Friedman-Korn , Tal Benoliel-Berman , Diya Doufish , Tzlil Shifman , Mordekhay Medvedovsky , Dana Ekstein

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引用次数: 0

Abstract

Purpose

Levetiracetam (LEV) is often a first-line epilepsy treatment due to its broad efficacy and favorable side effect profile. While LEV-induced seizure aggravation (LISA) has been reported in up to 18 % of LEV users in certain patient populations, the risk factors for LISA have not been well delineated. This study aims to provide a comprehensive assessment of seizure aggravation associated with LEV.

Methods

We conducted a comprehensive literature review of LISA case reports and case series. Additionally, we report a case series of seven patients treated at Hadassah Medical Center from 2015 to 2025 who experienced LISA.

Results

Our literature review identified 26 papers comprising 143 patient descriptions of LISA. Patients were 9 months to 80 years old, and seizure aggravation manifested as increased seizure frequency, status epilepticus, and the appearance of non-habitual seizures. Patients had both focal and generalized epilepsy, secondary to a variety of underlying lesion, and genetic mutation. LEV dosing ranged from 500 to 4500 mg per day. All patients in our case series experienced increased seizure frequency during LEV treatment, with two patients developing epilepsia partialis continua. Reducing or stopping LEV decreased seizures, sometimes leading to seizure freedom.

Conclusion

We found that LISA can occur across different age groups, epilepsy types and underlying etiologies. Clinicians should consider LISA in the differential diagnosis of seizure exacerbation following LEV treatment and evaluate the potential benefits of LEV discontinuation. Further studies are needed to determine the occurrence and risk factors of LISA to optimize ASM treatment.

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左乙拉西坦致癫痫加重病例系列及文献复习

摘要：左乙拉西坦（LEV）由于其广泛的疗效和良好的副作用，通常是一线治疗癫痫的药物。虽然在某些患者群体中，高达18%的LEV使用者报告了LEV诱发的癫痫发作加重（LISA），但LISA的危险因素尚未得到很好的描述。本研究旨在提供与LEV相关的癫痫发作加重的综合评估。方法对LISA病例报告和病例系列进行全面的文献回顾。此外，我们报告了2015年至2025年在哈达萨医疗中心治疗的7例LISA患者的病例系列。结果我们检索了26篇文献，其中包括143例LISA患者的描述。患者年龄为9个月至80岁，癫痫发作加重表现为癫痫发作频率增加、癫痫持续状态和出现非习惯性癫痫发作。患者有局灶性和全身性癫痫，继发于多种潜在病变和基因突变。LEV的剂量范围为每天500至4500毫克。在我们的病例系列中，所有患者在LEV治疗期间癫痫发作频率增加，其中2例发生部分持续性癫痫。减少或停止LEV可减少癫痫发作，有时可导致癫痫发作自由。结论LISA可在不同年龄组、不同癫痫类型和不同病因中发生。临床医生应在LEV治疗后癫痫发作的鉴别诊断中考虑LISA，并评估停用LEV的潜在益处。需要进一步研究确定LISA的发生及危险因素，以优化ASM的治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seizure-European Journal of Epilepsy 医学-临床神经学

CiteScore

5.60

自引率

6.70%

发文量

231

审稿时长

34 days

期刊介绍： Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.