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Levetiracetam – Antiepileptic Drug for Seizures

Levetiracetam is an antiepileptic drug used to treat epilepsy. It reduces seizure frequency and is approved for use in adults and children.

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Things worth knowing about "levetiracetam"

Levetiracetam is an antiepileptic drug used to treat epilepsy. It reduces seizure frequency and is approved for use in adults and children.

What is Levetiracetam?

Levetiracetam is a prescription medication belonging to the class of antiepileptic drugs (AEDs), also known as anticonvulsants. It is primarily used to control epileptic seizures. The drug is marketed under the brand name Keppra, among others, and is also widely available as a generic medicine. Levetiracetam was approved by the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA) in the early 2000s and has since become one of the most commonly prescribed antiepileptic medications worldwide.

Indications

Levetiracetam is indicated for the treatment of several seizure types:

Focal (partial) seizures with or without secondary generalization in adults, adolescents, and children from one month of age
Myoclonic seizures in adults and adolescents aged 12 and above with juvenile myoclonic epilepsy
Primary generalized tonic-clonic seizures in adults and adolescents aged 12 and above with idiopathic generalized epilepsy

It can be used as monotherapy or as an add-on (adjunctive) therapy alongside other antiepileptic medications.

Mechanism of Action

Levetiracetam has a unique mechanism of action that sets it apart from other antiepileptic drugs. It selectively binds to synaptic vesicle protein 2A (SV2A), a protein involved in the release of neurotransmitters at nerve synapses. By modulating SV2A, levetiracetam reduces the excessive and abnormally synchronized neuronal firing that causes epileptic seizures. Importantly, it has minimal effect on normal neuronal activity, which contributes to its relatively favorable tolerability profile.

Dosage and Administration

Levetiracetam is available in multiple formulations:

Film-coated tablets (oral, for adults and older children)
Oral solution (for children and patients who cannot swallow tablets)
Concentrate for intravenous infusion (when oral administration is not feasible)

The dosage is determined individually by the treating physician based on age, body weight, and seizure type. In adults, treatment typically starts at 250–500 mg twice daily and may be gradually increased up to a maximum of 3000 mg per day. Levetiracetam should never be stopped abruptly, as this may trigger rebound seizures. Dose reduction should always be gradual and supervised by a healthcare professional.

Side Effects

As with all medications, levetiracetam may cause side effects. Common side effects include:

Behavioral and psychiatric effects: Irritability, aggression, mood swings, anxiety, or depression
Neurological effects: Drowsiness, dizziness, headache, tremor
Infections: Increased susceptibility to upper respiratory tract infections
Gastrointestinal complaints: Nausea, vomiting, diarrhea

Rare but serious side effects include blood cell abnormalities, severe skin reactions, and suicidal ideation. Patients and caregivers should seek immediate medical attention if behavioral changes or worsening mood occur.

Drug Interactions

Compared to many other antiepileptic drugs, levetiracetam has a relatively low potential for drug interactions, as it is not significantly metabolized by the hepatic CYP450 enzyme system. However, the following interactions should be noted:

Combining levetiracetam with other central nervous system depressants (e.g., alcohol, sedatives) may enhance sedative effects
Probenecid may inhibit the renal elimination of levetiracetam, leading to increased plasma levels
Caution is advised when co-administering methotrexate

Special Considerations

In patients with impaired kidney function, dose adjustment is necessary since levetiracetam is primarily excreted by the kidneys. During pregnancy, levetiracetam should only be used after careful evaluation of the benefits and risks by the treating physician, as antiepileptic drugs may be associated with an increased risk of fetal malformations. Breastfeeding mothers should be aware that levetiracetam passes into breast milk.

References

Fisher RS et al. – Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia, 2017;58(4):531–542.
European Medicines Agency (EMA) – Keppra: Summary of Product Characteristics (SmPC). Available at: www.ema.europa.eu
Rogawski MA, Loscher W – The neurobiology of antiepileptic drugs. Nature Reviews Neuroscience, 2004;5(7):553–564.

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