Drug Use Review of Intravenous Levetiracetam in Patients with Epilepsy, Tertiary Care Hospital

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S81-S87
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Antiepileptic Drug ◽  
Line Treatment ◽  
First Line ◽  
Acute Seizure ◽  
Hospital Visits ◽  
Patients With Epilepsy ◽  
Control Seizure ◽  
First Line Treatment

Background: Epilepsy is a current important health problem. Status epilepticus is a medical emergency condition which may be lifethreatening, increased mortality rate and hospitalization. However, some patients with epilepsy could not control their symptoms and anticonvulsant medications have some adverse effects. Intravenous levetiracetam (ivLEV) is a new antiepileptic drug which its use tends to be increased. Objective: To study the prescription pattern of ivLEV and its adverse drug reactions (ADRs) in hospitalized patients and to define the efficacy of iv LEV as first line treatment for status epilepticus. Materials and Methods: This was a descriptive retrospective study to review medical records of all inpatients receiving ivLEV at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University during January 1st 2010 to December 31st 2014. Results: During the study period, there were 406 hospital visits that met the study criteria. The average age of the patients was 54.32+20.36 years with nearly equal sex distribution. The indications of ivLEV were status epilepticus (22.4%), previous treatment with oral levetiracetam (9.6%), perioperative craniectomy/craniotomy (8.6%), and acute seizure with non-status epilepticus (59%). Most of the patients (63.3%) received ivLEV as first line treatment antiepileptic drug and the most loading dose range of ivLEV that the patients received was 500 to 1,000 mg/day (78.3%). All of the patients had been followed vital signs and plasma electrolytes. 98.5% and 45.8% of hospital visits had been monitored liver/kidney function and electroencephalogram (EEG), respectively. Adverse effects during the treatment of ivLEV occurred 0.98%, which were hypotension, drowsiness, and maculopapular rash. No major ADRs were detected in any patients after the ivLEV treatment. Regarding process indicators, overall seizure control rate was 76.4%, of which 35.2% and 85.9% were for the patients with status epilepticus and acute seizure with non-status epilepticus, respectively. ivLEV could be used as first line treatment effectively in patients with status epilepticus (80.2%). In the patients with renal impairment receiving adjusted dosage regimen ivLEV could be control seizure 73.1%. Conclusion: The treatment of ivLEV was effective and safe for control seizure, including status epilepticus and acute seizure with non-status epilepticus. Thus, ivLEV could be the first line antiepileptic drug for the treatment of status epilepticus and brain surgery prevention. However, due to the high cost of the drug and the treatment course, there would be further study of cost-effectiveness. Keywords: Levetiracetam, Epilepsy, Acute seizure, Status epilepticus, Drug use review, Inpatient

Topical Timolol for Infantile Haemangioma of the Orbit

2021 ◽  
Vol 238 (10) ◽  
pp. 1069-1076
Author(s):  
Göran Darius Hildebrand ◽  
Zuzana Sipkova
Keyword(s):  
Adverse Effects ◽  
Beta Blockers ◽  
Close Monitoring ◽  
Line Treatment ◽  
Timolol Maleate ◽  
First Line ◽  
Benign Tumours ◽  
Meta Analyses ◽  
Oral Propranolol ◽  
First Line Treatment

AbstractInfantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.

scholarly journals Lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy

2016 ◽  
Vol 29 (4) ◽  
pp. 707-711 ◽  
Author(s):  
T Arrigo ◽  
PM Cutroneo ◽  
M Vaccaro ◽  
D Impollonia ◽  
V Squadrito ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Line Treatment ◽  
First Line ◽  
Inflammatory Dermatosis ◽  
First Case ◽  
Thyrotropin Level ◽  
Free Thyroxine Level ◽  
First Line Treatment

We reported a case of an 11-year-old girl admitted to our hospital for goiter, tachycardia, sweating, and visible and palpable thyroid. Thyroid function tests revealed a low thyrotropin level (<0.004 mIU/L) and elevated free thyroxine level (3.4 ng/ dL) diagnosed with Graves’ disease and treated with methimazole. This anti-thyroid drug is recommended as first-line treatment in children with Graves’ disease because it produces minor adverse effects with respect to propylthiouracil. She developed a lateralized exanthem mimicking figurate inflammatory dermatosis of infancy after methimazole therapy. The symptoms resolved after discontinuation of methimazole and treatment with an antihistamine and a corticosteroid. Furthermore, the treatment was changed to propylthiouracil without any adverse effects. According to current literature this is the first case of cutaneous figurate erythema related to methimazole, different from other well-known reactions such as skin eruption or urticaria.

Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus: A Two-Center Study

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012292
Author(s):  
Pia De Stefano ◽  
Sira Maria Baumann ◽  
Saskia Semmlack ◽  
Stephan Rüegg ◽  
Stephan Marsch ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Hospital Stay ◽  
Hospital Death ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Safety And Efficacy ◽  
Hospital Stays ◽  
Treatment Escalation ◽  
First Line Treatment

Objective:To explore safety and efficacy of artificial coma induction to treat status epilepticus (SE) immediately after first-line antiseizure treatment instead of following the recommended approach of first using second-line drugs.Methods:Clinical and electrophysiologic data of all adult patients treated for SE from 2017 to 2018 in the Swiss academic medical care centers from Basel and Geneva were retrospectively assessed. Primary outcomes were return to premorbid neurologic function and in-hospital death. Secondary outcomes were the emergence of complications during SE, duration of SE, ICU and hospital stay.Results:Of 230 patients, 205 received treatment escalation after first-line medication. Of those, 27.3% were directly treated with artificial coma and 72.7% with second-line non-anesthetic antiseizure drugs. Of the latter, 16.6% were subsequently put on artificial coma after failure of second-line treatment. Multivariable analyses revealed increasing odds for coma induction after first-line treatment with younger age, the presence of convulsions, and with an increased SE severity as quantified by the Status Epilepticus Severity Score (STESS). While outcomes and complications did not differ compared to patients with treatment escalation according to the guidelines, coma induction after first-line treatment was associated with shorter SE duration, ICU and hospital stay.Conclusions:Early induction of artificial coma is performed in more than every fourth patient and especially in younger patients presenting with convulsions and more severe SE. Our data demonstrate that this aggressive treatment escalation was not associated with an increase in complications but with shorter duration of SE, ICU and hospital stays.Classification of Evidence:This study provides Class III evidence that early induction of artificial coma after unsuccessful first-line treatment for SE is associated with shorter duration of SE, ICU and hospital stays compared to the use of a second-line non-anesthetic antiseizure drug instead or prior to anesthetics, without an associated increase in complications.

A Comparison of Four Treatments for Generalized Convulsive Status Epilepticus

2018 ◽  
pp. 21-26
Author(s):  
Jason L. Sanders ◽  
Jarone Lee
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Line Treatment ◽  
First Line ◽  
Cooperative Study Group ◽  
Intention To Treat ◽  
Intravenous Diazepam ◽  
Life Threatening ◽  
First Line Treatment

Generalized convulsive status epilepticus (GCSE) is a life-threatening emergency, and multiple agents have been advocated for the initial treatment. The VA Status Epilepticus Cooperative Study Group conducted a randomized, blinded trial comparing intravenous diazepam followed by phenytoin, lorazepam, phenobarbital, or phenytoin as first-line treatment for GCSE. In the intention-to-treat analysis, no significant difference in treatment was observed across all groups for patients with either overt GCSE or subtle GCSE. Among patients with verified-diagnosis overt GCSE, lorazepam was most successful at achieving cessation of seizures, though no difference was observed among patients with verified-diagnosis subtle GCSE. Results from this trial and two others establish benzodiazepines as the favored first line treatment of GCSE. Investigations are ongoing comparing benzodiazepines to newer antiepileptic drugs. The Established Status Epilepticus Trial will be the first randomized trial comparing fosphenytoin, levetiracetam, and valproic acid for benzodiazepine-refractory status epilepticus in children and adults.

Clinical experience with intravenous valproate as first-line treatment of status epilepticus and seizure clusters in selected populations

2013 ◽  
Vol 124 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Leonardo Lapenta ◽  
Alessandra Morano ◽  
Sara Casciato ◽  
Martina Fanella ◽  
Jinane Fattouch ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Clinical Experience ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals Status Epilepticus: The Slow and Agonizing Death of Phenytoin

2020 ◽  
Vol 25 (1) ◽  
pp. 4-6 ◽  
Author(s):  
Elizabeth A. Hall ◽  
James W. Wheless ◽  
Stephanie J. Phelps
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Drug Interactions ◽  
Mechanism Of Action ◽  
Adult Patients ◽  
Evidence Based ◽  
Insufficient Evidence ◽  
First Line ◽  
Acute Seizures ◽  
Acute Seizure

Since its introduction in 1950, phenytoin (PHT) has been the premier parenteral anticonvulsant used in the management of generalized convulsive status epileptics (GCSE) that is refractory to benzodiazepines. Without question, its arrival was vital to the care of patients with acute seizures and was a welcomed alternative to paraldehyde and phenobarbital. However, after more than half a century of use, there continues to be insufficient evidence-based data to support its efficacy over other anticonvulsants as a first-line agent in pediatric or adult patients with GCSE. This coupled with its narrow mechanism of action, complex pharmacokinetics and pharmacogenomics, drug-drug interactions, unique adverse effects, and formulation issues that make administration difficult mandates that PHT be replaced by safer and superiorly effective anticonvulsants for the treatment of GCSE when benzodiazepines are ineffective. We believe that levetiracetam should become the preferred agent for seizures unresponsive to or recurring after treatment with a benzodiazepine as it is at least equally effective to PHT and has several important advantages. PHT has overstayed its welcome and it is simply time for it to exit the realm of acute seizure management as a first-line agent for benzodiazepine-refractory GCSE.

scholarly journals Drugs and future candidates

2013 ◽  
Vol 5 (5-S2) ◽  
pp. 131
Author(s):  
Karl-Erik Andersson
Keyword(s):  
Overactive Bladder ◽  
Adverse Effects ◽  
Line Treatment ◽  
First Line ◽  
Bladder Filling ◽  
Antimuscarinic Drugs ◽  
Overall Effectiveness ◽  
First Line Treatment

Antimuscarinic drugs are still first-line treatment for the symptomsof overactive bladder (OAB) and are associated with good initialresponse rates. Adverse effects and decreasing efficacy overthe longer term do, however, limit their overall effectiveness. Assuch, alternatives to antimuscarinics are needed. The recognitionof the functional contribution of the urothelium, the spontaneousmyocyte activity during bladder filling, and the diversity of nervetransmitters involved in the symptoms of the OAB has sparkedinterest in pharmacologic manipulation of both peripheral andcentral pathophysiology. Some of the treatments currently underinvestigation are discussed in this review.

scholarly journals A Comparative Study on Intranasal Versus Intravenous Lorazepam in the Management of Acute Seizure in Children

Folia Medica ◽  
2021 ◽  
Vol 63 (6) ◽  
pp. 958-964
Author(s):  
Nandan Rudra ◽  
Taraknath Ghosh ◽  
Uttam Kumar Roy
Keyword(s):  
Emergency Situation ◽  
Pharmacokinetic Profile ◽  
Good Alternative ◽  
Cross Sectional Study ◽  
Medical Emergency ◽  
Line Treatment ◽  
First Line ◽  
Cross Sectional ◽  
Acute Seizure ◽  
First Line Treatment

Introduction: The acute seizure in childhood is a medical emergency which is usually managed by benzodiazepines used as a first line of therapy. There are no strict guidelines of using intranasal lorazepam in India. Many paediatricians use it in an emergency situation as it is inexpensive, easy to administer and even treatment can be started at home. Very few studies are available to compare efficacy and safety of intravenous lorazepam with intranasal lorazepam in childhood seizure, though both routes have comparable pharmacokinetic profile. Intravenous lorazepam (0.1 mg/kg) is already recommended as a first-line treatment of acute childhood seizures in India. There are very few studies regarding the usefulness of intranasal lorazepam. With this background, we compared intranasal lorazepam with the more widely accepted intravenous lorazepam for control of acute seizure. Aim: To compare effectiveness and safety of intranasal and intravenous lorazepam in acute seizure in children aged 5-12 years. Materials and methods: This is an analytical observational cross-sectional study involving patients with acute seizure who received lorazepam via either the intravenous or intranasal route. Formulation and dosage of lorazepam were the same in both routes. Results: Distributions of patient groups according to sex, age, and weight were statistically not significant (p=0.42, p=0.391, and p=0.605, respectively). Time to control seizure within 10 min and persistent cessation of seizure activity were similar in both groups. Safety parameters showed no differences statistically. Conclusions: Though intravenous lorazepam is recommended as first-line treatment, intranasal lorazepam may be a good alternative choice in a convulsing child.

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