Abstracts

RATIONALE: At the end of this activity the participants should be aware that pyridoxine may alleviate many or all of the levetiracetam induced behavioral side effects seen in young children, allowing continued use of levetiracetam.
Levetiracetam is a newly approved drug for adjunctive treatment of partial epilepsy. Levetiracetam use is associated with the occurrence of central nervous system adverse events classified as somnolence and fatigue, coordination difficulties, and behavioral abnormalities. Behavioral adverse events in children include insomnia, agitation, anxiety, emotional lability, and a hyperactive state. In rare instances hallucinations or psychosis have been induced. These adverse events often necessitate discontinuation of levetiracetam. A two-year old child with partial seizures secondary generalized had simultaneous initiation of pyridoxine (150mg/d) and levetiracetam (250mg/d). When the pyridoxine was discontinued two months later, hyperactivity and associated symptoms developed within one week. Within several days of reinstituting the pyridoxine the child[ssquote]s behavior became normal.
METHODS: Six patients, ages 2-10 years, 5 with partial or partial secondary generalized seizures and one child with migraine had behavioral adverse events to levetiracetam, severe enough to necessitate discontinuation. Levetiracetam dosage averaged 21mg/kg. Each child was treated with pyridoxine at an average dose of 7mg/kg.
RESULTS: Within one week behavioral side effects had resolved in five patients, or in one patient were minimal and acceptable to parents. All of the patients were neurologically and developmentally normal, and seizure free.
CONCLUSIONS: Pyridoxine appears to ameliorate behavioral adverse effects of levetiracetam in some children, especially normal children, thus allowing continued use of levetiracetam.
(Disclosure: Grant - KEEPER Trial, UCB, Consulting - UCB, Honoraria - Speakers Bureau UCB)