Levetiracetam for myoclonic seizures in idiopathic generalized epilepsy: A systematic review and meta-analysis

Levetiracetam (LEV) is an antiseizure medication (ASM) used for focal seizures and as an add-on therapy for some generalized epilepsies. In this meta-analysis, we aimed to compare the efficacy and safety of LEV with those of other ASMs in the specific setting of patients with IGE presenting myoclonic seizures, specially in JME.

We systematically searched Pubmed/MEDLINE, EMBASE, Cochrane Central, CAPES Journal Portal, and ICTRP for trials and cohorts from inception to January 2024. Studies enrolling patients with IGE presenting myoclonus or JME syndrome and comparing LEV to other ASMs were evaluated.

Eighteen studies including 2,189 patients met the inclusion criteria. Fifteen studies compared LEV to valproate, ten compared LEV to lamotrigine, two compared LEV to placebo, and four compared LEV to topiramate. There was no significant difference between LEV and valproate seizure freedom rates in both the RCT (OR = 0.77; 95 % CI: 0.39 to 1.55; p = 0.47) and non-RCT groups (OR = 0.94; 95 % CI: 0.62 to 1.44; p = 0.78). LEV was more likely to be associated with seizure freedom than lamotrigine in the non-RCT group (OR = 2.22; 95 %CI: 1.61 to 3.05; p < 0.001), topiramate (OR: 1.93; 95 % CI: 1.10 to 3.36; p < 0.05), and placebo (OR: 4.88; 95 % CI: 1.73 to 13.77, p < 0.05).

Levetiracetam may be considered for myoclonic seizures in IGE. The safety of levetiracetam during pregnancy and its similar efficacy to valproate suggest that people of childbearing potential are most likely to benefit from it.