Intravenöses Levetiracetam zur Therapie des Status epilepticus –Eine retrospektive Erhebung
Loading...
Files
Date
relationships.isAuthorOf
Publisher
Philipps-Universität Marburg
item.page.supervisor-of-thesis
Abstract
Status epilepticus (SE) is one of the most common neurological emergencies. It is
associated with high morbidity and a mortality rate of 16-26%. Treatment needs to be
early and efficient, but the medical treatment of SE often fails and has many side effects
and contraindications. Firstline medicaments in the treatment of SE are benzodiazepines
and phenytoine, but also valproate and barbiturates are used. However treatment with
this medication is often ineffective. In addition there are many contraindications and
possible side effcts to consider, especially in elderly with comorbidities and
comedications. Examples for contraindications are arrhythmia for phenytoine,
liverdamage for valproate and cardiovascular instability for barbiturates.
Since the year 2000 levetiracetam is approved as an oral anticonvulsive drug. In oral
application it proved to have low side effects and few interactions. Unwanted side
effects are mainly dizziness, fatigue and changes in mood, especially aggressiveness.
As the first of the newer anticonvulsive drugs, since 2006 it is also available for
intravenous application. It has been approved for cases in which oral application is not
possible .
In this study there was retrospectively collected data over a period of time of 18 months.
Included were all patients who received intravenous levetiracetam within an individual
curative effort. While collecting data there was special attention on effectiveness of the
medicament and the occurence of adverse events.
In total there were included 19 cases in 17 different patients.
The analysis of the data showed, that the underlying seizure was focal in all 19
episodes. Four times with secondary generalisation, three times as a non-convulsive SE.
In eight cases the diagnosis of epilepsy was already known, in eleven patients it was the
first incidence. Causes of the SE were on the one hand longterme diseases like
intracranial tumors or former bleedings, on the other hand acute incidents like metabolic
imbalance or hemorrhagic or ischemic stroke. In five cases the reason of SE remained
unknown.
In all episodes the SE was refractory to benzodiazepines. In seven cases also the
application of another anticonvulsive drug than levetiracetam was ineffective.
In total 17 of 19 cases of SE could be ceased by the application of intravenous
levetiracetam. In two cases further medication had to be added.
44
Severe adverse events caused by the medicament or its form of application have not
been observed. Observed side effects were mainly mood changes, two patients died due
to their underlying diseases.
At the time of this study there was no publication about a series of cases regarding this
issue. The studies with similar design published later, showed similar results.
It is also worth mentioning that in all studies focal and generalised as well as nonkonvulsive
SE were effectively treated with intravenous levetiracetam. This underlines
the importance of this medicament as a “broad-spectrum” anticonvulsive drug.
The present study confirms the assumption that levetiracetam could be a safe and
effective medicament in refractory status epilepticus.
The significance of the study however is limited especially due to its retrospective
design as well as the small group of patients and a large prospective randomised study is
warranted to explore effectiveness and longterm tolerance.
Review
Metadata
Contributors
Supervisor:
Dates
Created: 2011Issued: 2011-04-29Updated: 2011-08-08
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
LevetiracetamLevetiracetam
DFG-subjects
Levetiracetam
DDC-Numbers
610
show more
Grüner, Judith: Intravenöses Levetiracetam zur Therapie des Status epilepticus –Eine retrospektive Erhebung. : Philipps-Universität Marburg 2011-04-29. DOI: https://doi.org/10.17192/z2011.0338.
License
This item has been published with the following license: In Copyright