title: Role of high-dose levetiracetam as add-on therapy for intractable epilepsy: case report and brief review of the literature.
abstract: METHODS
  We discuss the case of a 5-year-old long-standing epileptic woman, who received oxcarbazepine 2.1 g/day, and levetiracetam 3 g/day (started in 2005 and up-titrated according to response). In October/2008, due to poor seizure control, patient consent was obtained and levetiracetam up-titrated to 6 g/day, remaining invariable for 72 months; zonisamide was added in July/2009 and up-titrated to 500 mg/day. This combination achieved seizure frequency reduction ≥50 %, however, the patient ultimately necessitated temporal lobectomy for complete remission. Occasional agitation and moderate depression were the main side effects.
  
  
  CONCLUSIONS
  Three anti-epileptic drugs (including levetiracetam 6 g/day) achieved statistically-significant seizure frequency reduction ≥50 % compared with lower doses, but not seizure freedom. Low-dose risperidone was initiated due to transient dose-dependent agitation, although it did not lead to discontinuation. This report provides insightful information on the use of high-dose levetiracetam in focal refractory epilepsy. The concomitance of anti-epileptics may have contributed to both efficacy and toxicity. Therefore, the risk/benefit ratio must be individually weighed until larger studies are available.
authors.affiliation: Pharmacy Department, Northampton General Hospital NHS Trust, Cliftonville, Northampton, NN1 5BD, UK, Hector.Mateo-Carrasco@ngh.nhs.uk.
authors.forename: Hector
authors.initials: H
authors.lastname: Mateo-Carrasco
authors.forename: Pedro Jesús
authors.initials: PJ
authors.lastname: Serrano-Castro
authors.forename: Emilio
authors.initials: E
authors.lastname: Molina-Cuadrado
authors.forename: Mel
authors.initials: M
authors.lastname: Goodwin
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Nguyen
authors.forename: Primal N
authors.initials: PN
authors.lastname: Kotecha
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002220:Carbamazepine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D000078330:Oxcarbazepine; D010889:Piracetam / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D000077287:Levetiracetam; D000078330:Oxcarbazepine; D010889:Piracetam
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