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Intravenous levetiracetam seems to be an effective, safe antiepileptic drug in hospitalised patients, and especially so in those who present an associated comorbidity and/or who are on multiple drug therapy 1)

Levetiracetam (LEV) is the most potent O6 methylguanine DNA methyltransferase (MGMT)inhibitor among several antiepileptic drugs (AEDs) with diverse MGMT regulatory actions. In vitro, when used at concentrations within the human therapeutic range for seizure prophylaxis, LEV decreases MGMT protein and mRNA expression levels. Chromatin immunoprecipitation analysis reveals that LEV enhances p53 binding on the MGMT promoter by recruiting the mSin3A/histone deacetylase 1 (HDAC1) corepressor complex. However, LEV does not exert any MGMT inhibitory activity when the expression of either p53, mSin3A, or HDAC1 is abrogated. LEV inhibits malignant glioma cell proliferation and increases glioma cell sensitivity to the monofunctional alkylating agent temozolomide. In 4 newly diagnosed patients who had 2 craniotomies 7-14 days apart, prior to the initiation of any tumor-specific treatment, samples obtained before and after LEV treatment showed the inhibition of MGMT expression. This results suggest that the choice of AED in patients with malignant gliomas may have an unrecognized impact in clinical practice and research trial design 2).

Levetiracetam LEV may provide a survival benefit in patients with glioblastoma who receive temozolomide-based chemotherapy. A prospective randomized study may be indicated 3)

Levetiracetam appears effective and safe for seizure prevention in patients undergoing brain tumor resection and who are at significantly higher risk of developing post-operative seizures. These findings warrant confirmation in a prospective randomized trial 4).

see Levetiracetam for hemifacial spasm.

Giner-Bernabeu JC, Hernández-Rubio L, Sempere AP, Bosacoma-Ros N, Berenguer-Ruiz L, Lezcano-Rodas M, Martínez-Lazcano T, Mira-Berenguer F, Baño E, Abarca-Olivas J, Duart M, Asensio-Asensio M. [The use of intravenous levetiracetam in a general hospital]. Rev Neurol. 2009 Nov 16-30;49(10):517-9. Spanish. PubMed PMID: 19859874.
Bobustuc GC, Baker CH, Limaye A, Jenkins WD, Pearl G, Avgeropoulos NG, Konduri SD. Levetiracetam enhances p53-mediated MGMT inhibition and sensitizes glioblastoma cells to temozolomide. Neuro Oncol. 2010 Sep;12(9):917-27. doi: 10.1093/neuonc/noq044. PubMed PMID: 20525765; PubMed Central PMCID: PMC2940696.
Kim YH, Kim T, Joo JD, Han JH, Kim YJ, Kim IA, Yun CH, Kim CY. Survival benefit of levetiracetam in patients treated with concomitant chemoradiotherapy and adjuvant chemotherapy with temozolomide for glioblastoma multiforme. Cancer. 2015 Sep 1;121(17):2926-32. doi: 10.1002/cncr.29439. PubMed PMID: 25975354.
Gokhale S, Khan SA, Agrawal A, Friedman AH, McDonagh DL. Levetiracetam seizure prophylaxis in craniotomy patients at high risk for postoperative seizures. Asian J Neurosurg. 2013 Oct;8(4):169-73. doi: 10.4103/1793-5482.125658. PubMed PMID: 24550999; PubMed Central PMCID: PMC3912766.
levetiracetam.txt · Last modified: 2018/07/29 23:24 by administrador