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Levetiracetam

(Keppra®)

Levetiracetam

Drug updated on 4/17/2024

Dosage FormTablet (oral; 250 mg, 500 mg, 750 mg, 1000 mg); Solution (oral; 100 mg/mL)
Drug ClassSynaptic vesicle protein SV2A regulators
Ongoing and
Completed Studies		ClinicalTrials.gov

Indication

  • Indicated for the treatment of partial-onset seizures in patients 1 month of age and older.
  • Indicated for the treatment of adjunctive therapy for the treatment of myoclonic seizures in patients 12 years of age and older with juvenile myoclonic epilepsy.
  • Indicated for the treatment of adjunctive therapy for the treatment of primary generalized tonic-clonic seizures in patients 6 years of age and older with idiopathic generalized epilepsy.

Summary
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  • Levetiracetam (Keppra) is indicated for the treatment of partial-onset seizures in patients 1 month of age and older, myoclonic seizures in patients 12 years and older with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in patients 6 years old or more with idiopathic generalized epilepsy.
  • Twenty-three studies were analyzed to gather information about levetiracetam's efficacy and safety compared to other antiseizure medications.
  • Compared to Phenobarbital for neonatal seizure management, levetiracetam was found to be non-inferior regarding seizure control but had a better short-term neurodevelopment outcome. It also showed a lower incidence rate of hypotension, respiratory depression, and depressed sensorium, indicating its superior safety profile.
  • For Idiopathic Generalized Epilepsies (IGEs), although valproate appeared more effective overall, levetiracetam was the best for managing myoclonic seizures. Its role as adjunctive therapy showed promise, especially for treating myoclonic seizures alone or combined with generalized tonic-clonic ones.
  • Among Antiseizure Medications (ASMs) used against drug-resistant focal-onset seizures, lamotrigine, oxcarbazepine, along with levetiracetam were highlighted for their effectiveness at reducing these types of epileptic episodes. Moreover, it demonstrated the highest probability among ASMs at achieving complete freedom from such attacks.
  • When addressing drug-resistant symptomatic myoclonus or those who did not respond to valproate treatments, perampanel proved efficient, whereas levetiracetam was effective when initially administered in these cases, showing its versatility across different patient groups and conditions.
  • Levetiracetam has shown promising anti-seizure properties when managing neonatal convulsive status epilepticus, similar to phenytoin but with fewer seizure recurrences and lower intubation requirements. It also showed non-inferiority in seizure freedom rates for newly diagnosed focal epilepsy compared to oxcarbazepine, while offering a better safety profile.
  • Across various conditions (e.g., intracerebral hemorrhage, traumatic brain injury, subarachnoid hemorrhage, supratentorial neurosurgery), levetiracetam did not significantly reduce the incidence of seizures compared to placebo or other ASMs but was associated with fewer adverse events, indicating its favorable safety profile.

Product Monograph / Prescribing Information

Document TitleYearSource
Keppra (levetiracetam) Prescribing Information.2023UCB Inc., Smyrna, GA

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Levetiracetam versus phenobarbitone for management of neonatal seizures: a systematic review and meta-analysis. 2023Indian Journal of Pediatrics
Antiseizure medications for idiopathic generalized epilepsies: a systematic review and network meta-analysis. 2023Journal of Neurology
Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child.2023The Cochrane Database of Systematic Reviews
Efficacy of Levetiracetam in neonatal seizures: a systematic review.2022The Journal of Maternal-Fetal & Neonatal Medicine
Comparative antiseizure medications of adjunctive treatment for children with drug-resistant focal-onset seizures: a systematic review and network meta-analysis. 2022Frontiers in Pharmacology
A systematic review of the efficacy of perampanel as treatment for myoclonic seizures and symptomatic myoclonus. 2022Epileptic Disorders
Indirect treatment comparison of cenobamate to other ASMs for the treatment of uncontrolled focal seizures. 2022Epilepsy and Behavior
Levetiracetam versus oxcarbazepine as monotherapy in newly diagnosed focal epilepsy: a systematic review and meta-analysis.2022Brain and Behavior
Levetiracetam for seizure prophylaxis in neurocritical care: a systematic review and meta-analysis.2021Neurocritical Care
Levetiracetam as the first-line treatment for neonatal seizures: a systematic review and meta-analysis.2021Developmental Medicine & Child Neurology
Efficacy and safety of levetiracetam vs. phenobarbital for neonatal seizures: a systematic review and meta-analysis.2021Frontiers in Neurology
Efficacy and safety of levetiracetam vs. phenytoin as second line antiseizure medication for pediatric convulsive status epilepticus: a systematic review and meta-analysis of randomized controlled trials.2021Journal of Tropical Pediatrics
Efficacy of levetiracetam for migraine prophylaxis: a systematic review and meta-analysis.2021Journal of Formosan Medical Association
Treating the symptom or treating the disease in neonatal seizures: a systematic review of the literature.2021Italian Journal of Pediatrics
Efficacy and safety of levetiracetam versus (fos)phenytoin for second-line treatment of epilepticus: a meta-analysis of latest randomized controlled trials.2021Seizure
Sulthiame monotherapy for epilepsy.2021The Cochrane Database of Systematic Reviews
Comparative efficacy of anti-epileptic drugs for neonatal seizures: a network meta-analysis. 2021Pediatrics and Neonatology
Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: a systematic review.2021Epilepsy and Behavior
Levetiracetam and cutaneous adverse reactions: a systematic review of descriptive studies.2020Seizure European Journal of Epilepsy
Levetiracetam add-on for drug-resistant focal epilepsy. 2020The Cochrane Database of Systematic Reviews
Antiepileptic drug monotherapy for epilepsy in the elderly: a systematic review and network meta-analysis. 2019Epilepsia
The medical treatment of epilepsy in the elderly: a systematic review and meta-analysis.2019Epilepsia
Efficacy and safety of levetiracetam as adjunctive treatment in children with focal onset seizures: a systematic review and meta-analysis. 2019Epilepsy Research
Pregabalin add-on for drug-resistant focal epilepsy.2019The Cochrane Database of Systematic Reviews

Clinical Practice Guidelines

Document TitleYearSource
Treatment of seizures in the neonate: Guidelines and consensus-based recommendations - special report from the ILAE task force on neonatal seizures.2023Epilepsia