Levetiracetam add-on for drug-resistant localization related (partial) epilepsy

Chaisewikul R, Privitera MD, Hutton JL, Marson AG

Published Online:

January 20, 2010

Levetiracetam is effective as an add-on treatment for drug-resistant localization related (partial) epilepsy.

Epilepsy is a disorder where recurrent seizures are caused by abnormal electrical discharges from the brain. Most seizures can be controlled by a single antiepileptic drug but sometimes they are resistant to those drugs. The review of trials found that the new drug, levetiracetam, is effective when used with other drugs to reduce the number of seizures in drug-resistant localization related epilepsy. Adverse effects were dizziness and infection and more research is needed to compare antiepileptic drugs currently available.

Abstract (click to read)

Background:

The majority of people with epilepsy have a good prognosis and their seizures are well controlled by a single antiepileptic drug. However, up to 30% develop refractory seizures, particularly those with partial onset seizures. In this review we summarize the current evidence regarding a new antiepileptic drug, levetiracetam, when used as an add-on treatment for drug-resistant localization related (partial) epilepsy.

Objectives:

To evaluate the effects of levetiracetam when used as an add-on treatment for people with drug-resistant localization related epilepsy.

Search strategy:

We searched the Cochrane Epilepsy Group's Specialized Register (July 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), and MEDLINE (1966 to March 2005). No language restrictions were imposed. We also contacted the manufacturers of levetiracetam and researchers in the field to seek any ongoing or unpublished studies.

Selection criteria:

Randomized placebo controlled add-on trials of levetiracetam in people with drug-resistant localization related epilepsy.

Data collection and analysis:

Two review authors independently selected trials for inclusion and extracted data. Outcomes investigated included: 50% or greater reduction in seizure frequency; treatment withdrawal; adverse effects; cognitive effects and quality of life. Primary analyses were intention-to-treat. Dose response was evaluated in regression models.

Main results:

Four trials (1023 participants) were included. The overall odds ratio (OR) with 95% confidence intervals (CIs) for 50% or greater reduction in seizure frequency outcome was 3.81 (95% CI 2.78 to 5.22). Dose regression analysis shows clear evidence that levetiracetam reduces seizure frequency with an increase in efficacy with increasing dose of levetiracetam. Approximately 15% or people taking 1000 mg and 20 to 30% of people taking 3000 mg levetiracetam per day have a 50% or greater reduction in seizure frequency. Participants were not significantly more likely to have levetiracetam withdrawn, OR 1.25 (95% CI 0.87 to 1.80). The following adverse effects were significantly associated with levetiracetam: dizziness 2.36 (95% CI 1.21 to 4.61) and infection 1.82 (95% CI 1.05 to 3.14) whereas accidental injury was significantly associated with placebo 0.55 (95% CI 0.32 to 0.93). Quality of life and cognitive effect outcomes suggest that levetiracetam has a positive effect on cognition and some aspects of quality of life.

Authors' conclusions:

Levetiracetam reduces seizure frequency when used as an add-on treatment for people with drug-resistant localization related epilepsy, and seems well tolerated. The trials were of 16 to 24 weeks duration and results cannot be used to confirm longer term effects.

This record should be cited as:

Chaisewikul R, Privitera MD, Hutton JL, Marson AG. Levetiracetam add-on for drug-resistant localization related (partial) epilepsy. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD001901. DOI: 10.1002/14651858.CD001901

Assessed as up to date:

July 1, 2005

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Primary Review Group:

Epilepsy Group

Health topics:

Neurology > Epilepsy > Drugs for broad populations

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Levetiracetam add-on for drug-resistant localization related (partial) epilepsy

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