Koubeissi M Z, Amina S, Pita I, Bergey G K, Werz M A
Department of Neurology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5040, USA.
Neurology. 2008 May 27;70(22 Pt 2):2166-70. doi: 10.1212/01.wnl.0000313151.64005.c0.
Nonsedating antiepileptic drugs (AEDs) that can be initiated rapidly are desirable in a variety of clinical situations. Levetiracetam (LEV) is a newer AED, with a recently approved parenteral formulation, that can be initiated at doses effective in controlling seizures. We investigated whether oral loading of levetiracetam is well tolerated and facilitates stabilization and discharge of patients in epilepsy monitoring units (EMU).
Adult patients in the EMU at two centers were identified who received 1,500 mg of LEV in a single dose. This was an observational study of these patients where LEV was thought to be an appropriate component of the therapeutic regimen. Patients were either LEV naive or had been off all LEV for at least 3 days. LEV maintenance was begun 12 hours later at doses of 500 to 1,000 mg twice a day.
A total of 37 adult patients (20 female) were identified. There were no spontaneous complaints of side effects. Upon questioning, 33 patients (89%) denied side effects. The remaining 4 patients (11%) reported transient irritability, imbalance, tiredness, or lightheadedness. Eleven patients (mean weight = 85.0 Kg) had mean LEV serum concentration of 31.5 microg/mL after 1 hour, 23 (mean weight 85.7 Kg) had mean concentration of 30.77 microg/mL after 2 hours, five (mean weight 84.3 Kg) had mean concentration of 12.1 microg/mL after 12 hours, and two (mean weight 94 Kg) had mean concentration of 7.4 microg/mL after 14 hours. No seizures occurred within 24 hours of loading. All patients were able to be discharged 3 to 30 hours after loading.
In the population surveyed, oral loading with levetiracetam was well-tolerated and rapidly yielded serum concentrations thought to decrease seizure frequency. This regimen facilitated discharge from the epilepsy monitoring units.
在多种临床情况下，都需要能快速起始使用的非镇静性抗癫痫药物（AEDs）。左乙拉西坦（LEV）是一种较新的AED，其肠胃外制剂最近已获批准，可采用能有效控制癫痫发作的剂量起始使用。我们研究了左乙拉西坦口服负荷剂量是否耐受性良好，以及是否有助于癫痫监测单元（EMU）中的患者病情稳定并出院。
确定了两个中心的EMU中的成年患者，他们接受了单次剂量1500 mg的左乙拉西坦。这是一项针对这些患者的观察性研究，其中左乙拉西坦被认为是治疗方案的一个合适组成部分。患者要么此前未使用过左乙拉西坦，要么已停用所有左乙拉西坦至少3天。12小时后开始左乙拉西坦维持治疗，剂量为每日两次，每次500至1000 mg。
共确定了37例成年患者（20例女性）。没有患者自发抱怨有副作用。经询问，33例患者（89%）否认有副作用。其余4例患者（11%）报告有短暂的易怒、失衡、疲倦或头晕。11例患者（平均体重 = 85.0 Kg）在1小时后左乙拉西坦血清平均浓度为31.5 μg/mL，23例患者（平均体重85.7 Kg）在2小时后平均浓度为30.77 μg/mL，5例患者（平均体重84.3 Kg）在12小时后平均浓度为12.1 μg/mL，2例患者（平均体重94 Kg）在14小时后平均浓度为7.4 μg/mL。负荷剂量后24小时内未发生癫痫发作。所有患者在负荷剂量后3至30小时均可出院。
在所调查的人群中，左乙拉西坦口服负荷剂量耐受性良好，并能迅速产生据信可降低癫痫发作频率的血清浓度。该方案有助于从癫痫监测单元出院。
