The effectiveness of Levetiracetam (Keppra) for hard occurring forms of epilepsy in children
It should immediately be said about the rather complex problem of age limits in the use of this drug. In international practice keppra authorized for use as adjunctive therapy in the treatment of partial seizures with secondary generalization and without adults and children 4 years and older. As monotherapy is widely used in Europe.
Given the extensive international experience of application, good tolerability and high effectiveness, the drug during the last 3 years, appointed us children over 2 years of age with epilepsy. As a rule, it is the patients who first monotherapy or polytherapy previous attempts proved to be extremely ineffective or poorly tolerated.
Prerequisite purpose of the drug is to inform our parents of the patient about the difficulties associated with the time of registration of the drug and age restrictions. The first experience of Keppra was associated with children, which this drug was appointed abroad.
Levetiracetam drug use
We do not accidentally give preference to levetiracetam other new antiepileptic drugs.
Keppra has a broad spectrum of therapeutic activity and can be used in almost all generalized and focal (idiopathic and symptomatic) epilepsy syndromes.
We have confirmed the high efficacy of Keppra in the treatment of particularly severe epileptic myoclonus.
Levetiracetam (Keppra) treatment
In severe myoclonic epilepsy of infancy malignant received Keppra 6 people. (Age 2 to 4 years). In 2 children with seizures monotherapy fully cropped. Dose was 40-50 mg / kg / day in two divided doses. 3 children there was a significant reduction in seizure frequency in the treatment of adding syrup depakine circuit 20 mg / kg / day. Keppra The dose was 30-50 mg / kg / day. In one case, we did not achieve the desired effect. The treatment was administered at a dose depot sinakten keppra 80 mg / kg / day.
Keppra was appointed 4 people. with Lennox - Gastaut syndrome (age 5-8 years). One child was able to completely arrest the seizures (monotherapy). In 2 cases, there was a sharp decrease in the number of attacks (in combination with chrono Depakinum at 30 / mg / kg / day).
3 children with myoclonic-astatic epilepsy of early childhood Dooze (age 2-3 years) showed the maximum positive results when taking Keppra. Dose in all cases was 40-60 mg / kg / day. All children achieved clinical remission for 2 years. Two patients were on at the same time prolonged use of corticosteroids (sinakten depot / m for 8-10 months.). In 5 children with juvenile myoclonic epilepsy Gerpina - Janz (age 9-14 years) use of Keppra results were as follows: 2 persons. - The absence of seizures within 18 months. (Dose - 70 mg / kg / day) .; 2 people. - Total absence seizures achieved in combination with chrono Depakinum (35 mg / kg / day); 1 person. - Reduction in seizure frequency combined with valproate.
Successful application Keppra as we alone have been reported in the treatment of not only severe epileptic syndromes, and benign focal epilepsy centrotemporal spikes (2 males at the age of 8 and 10 years old, a dose - 40 mg / kg / day), as well as polytherapy - when its resistance flow (in conjunction with enkoratom Depakine chrono chrono or 30 mg / kg / day).
Keppra can be effective in the treatment of epilepsy resistant in relation to other anticonvulsants and provides fast, sometimes very fast, the therapeutic effect. It is a drug with a rapid rate of administration, and dose titration is not necessary.
According to our data, if the child weighs 20 to 40 kg, the drug once prescribed 250 mg 2 times a day, for 3-4-th week - 500 mg 2 times a day, if necessary, the dose can be increased further. But when using a dose of 500 mg / day, we noted the clinical effect of reducing the frequency of seizures, ie starting dose has a therapeutic and did not require further purpose of maximum doses. In children weighing 40-60 kg administered once Keppra 500 mg 2 times a day, 2 weeks - 1000 mg 2 times a day.
The exact dose determined by the particular clinical situation, and in our practice ranged from 20 to 80 mg / kg / day in two divided doses. Our clinical experience allows us to confirm the widespread view that keppra starts from the first day of treatment.
The minimum period of clinical remission in patients taking levetiracetam our clinic was 3 months. (Severe myoclonic epilepsy of infancy malignant Drava), the maximum - 2 years (myoclonic-astatic epilepsy Dooze).
Keppra is well combined with other anti-epileptic drugs. According to our data, the drug does not affect the concentration of other anticonvulsants. With his admission were observed clinically significant fluctuations in blood drug. We used a successful combination with valproate levetiracetam.
Keppra - one of the well-tolerated anticonvulsant. It does not suppress, but rather stimulates cognitive functions that cognitive evoked potentials confirmed by (P300). In our clinic, in any case, there was no side effect that would require discontinuation of the drug. Of the 18 cases of Keppra in one patient (12 years old boy) was observed sleepiness during the week of the administration, and in 2 cases the children complained of nausea. These effects were reversible.
It is extremely important to note the fact that Keppra did not break the function of the liver (for the entire course of treatment did not change the level of bilirubin, transaminases and liver enzymes) and did not have a negative impact on cognitive abilities of patients.
Thus, we can state that levetiracetam is highly effective and safe anti-epileptic drugs and can be used as an alternative or complementary therapy in severe forms of epilepsy in children.