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Levetiracetam Monotherapy in Children with Epilepsy: A Systematic Review
Amerins Weijenberg1, Oebele F Brouwer1, Petra M C Callenbach2
1Department of Neurology, University Medical Centre Groningen, University of Groningen, AB 51, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.
Insights
Levetiracetam shows promise as monotherapy for pediatric epilepsy, but current evidence is limited. More rigorous trials are needed to confirm its efficacy and tolerability in children across various seizure types.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- Levetiracetam is a second-generation anti-epileptic drug (AED) approved for focal seizures in individuals over 16.
- Off-label use in younger children is increasing despite limited formal evidence.
Purpose of the Study:
- To critically review the evidence for levetiracetam monotherapy in children aged 0-16.
- To discuss the current status of its use in this population.
Main Methods:
- Systematic literature search of PubMed, Web of Science, and Embase up to August 2014.
- Keywords: levetiracetam, monotherapy, child*.
- Evaluation of 532 titles/abstracts, with full-text assessment of 52 relevant articles.
Main Results:
- Review included 32 studies (4 RCTs, 10 prospective, 8 retrospective, 10 case reports).
- Formal evidence for levetiracetam monotherapy in children is minimal.
- Potentially efficacious for benign epilepsy with centrotemporal spikes; generally good efficacy and tolerability comparable to other AEDs.
Conclusions:
- Data from 32 studies are insufficient to confirm levetiracetam's efficacy as initial monotherapy for diverse pediatric epilepsy syndromes.
- Urgent need for well-designed trials to support widespread use in children of all ages.
Background:
Levetiracetam, a second-generation anti-epileptic drug (AED) with a good efficacy and safety profile, is licensed as monotherapy for adults and children older than 16 years with focal seizures with or without secondary generalization. However, it is increasingly being used off-label in younger children.
Objectives:
We critically reviewed the available evidence and discuss the present status of levetiracetam monotherapy in children 0-16 years old.
Data Sources:
We systematically searched the literature using PubMed, Web of Science and Embase up to August 2014 for articles on levetiracetam monotherapy in children. Keywords were levetiracetam, monotherapy and child*. The titles and abstracts of 532 articles were evaluated by AW, of which 480 were excluded. The full texts of the other 52 articles were assessed for relevance.
Results:
We covered one review, one opinion statement and 32 studies in this review, including four randomized controlled trials, ten open-label prospective studies, eight retrospective studies, and ten case reports. The formal evidence for levetiracetam monotherapy in children is minimal: it is potentially efficacious or effective as initial monotherapy in children with benign epilepsy with centrotemporal spikes. In all of the published studies, however, efficacy and tolerability of levetiracetam seemed to be good and comparable to other AEDs.
Conclusion:
The data of 32 studies on levetiracetam monotherapy in children were insufficient to confirm that levetiracetam is effective as initial monotherapy for different types of seizures and/or epilepsy syndromes. There is still an urgent need for well designed trials to justify the widespread use of levetiracetam monotherapy in children of all ages.
