• Hector Mateo-Carrasco, Pedro Jesús Serrano-Castro, Emilio Molina-Cuadrado, Mel Goodwin, Timothy V Nguyen, and Primal N Kotecha.
• Pharmacy Department, Northampton General Hospital NHS Trust, Cliftonville, Northampton, NN1 5BD, UK, Hector.Mateo-Carrasco@ngh.nhs.uk.
• Int J Clin Pharm. 2015 Aug 1; 37 (4): 559-62.

CaseWe discuss the case of a 5-year-old long-standing epileptic woman, who received oxcarbazepine 2.1 g/day, and levetiracetam 3 g/day (started in 2005 and up-titrated according to response). In October/2008, due to poor seizure control, patient consent was obtained and levetiracetam up-titrated to 6 g/day, remaining invariable for 72 months; zonisamide was added in July/2009 and up-titrated to 500 mg/day. This combination achieved seizure frequency reduction ≥50 %, however, the patient ultimately necessitated temporal lobectomy for complete remission. Occasional agitation and moderate depression were the main side effects.ConclusionThree anti-epileptic drugs (including levetiracetam 6 g/day) achieved statistically-significant seizure frequency reduction ≥50 % compared with lower doses, but not seizure freedom. Low-dose risperidone was initiated due to transient dose-dependent agitation, although it did not lead to discontinuation. This report provides insightful information on the use of high-dose levetiracetam in focal refractory epilepsy. The concomitance of anti-epileptics may have contributed to both efficacy and toxicity. Therefore, the risk/benefit ratio must be individually weighed until larger studies are available.

26 keywords...

hide…