Sheinberg Revital, Heyman Eli, Dagan Zahi, Youngster Ilan, Kohn Elkana, Gandelman-Marton Revital, Berkovitch Matitiahu
Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.
Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Neurol. 2015 Jun;52(6):624-8. doi: 10.1016/j.pediatrneurol.2015.01.012. Epub 2015 Jan 29.
Levetiracetam is used as adjunctive therapy in various types of seizures. Studies evaluating the effect of levetiracetam on children with refractory epilepsy are scarce. The aim of this study was to evaluate the correlation between serum concentration of levetiracetam and either efficacy or tolerability in children with refractory epilepsy, and to determine the value of levetiracetam blood level monitoring.
Medical records of 50 children with refractory epilepsy treated with levetiracetam and regularly followed at Assaf Harofeh Medical Center were retrospectively reviewed. Trough serum levetiracetam concentration was determined using high-performance liquid chromatography and correlated with the administered dose and clinical report.
No correlation between levetiracetam serum levels and clinical efficacy, tolerability or administered dosage was found. The average dose of levetiracetam was 43.7 ± 20.0 (range 14-100) mg/kg/day and the average serum concentration was 16.0 ± 9.5 (range 2.5-38.5) μg/mL. Forty-five patients (95%) had more than a 50% reduction of seizure frequency, with 22 (44%) patients becoming seizure-free for at least 6 months. Adverse events related to levetiracetam were reported in 15 (30%) patients. No correlation between serum concentrations and adverse events was found. These results were not affected by gender, age, type of seizure, and other drugs.
Determination of serum concentration is not needed in all children treated with levetiracetam. Serum concentrations may be valuable either in patients with refractory epilepsy for compliance evaluation or in patients with satisfactory control of seizures for determination of their therapeutic baseline.
左乙拉西坦用作各种类型癫痫发作的辅助治疗。评估左乙拉西坦对难治性癫痫患儿疗效的研究较少。本研究的目的是评估左乙拉西坦血清浓度与难治性癫痫患儿疗效或耐受性之间的相关性，并确定左乙拉西坦血药浓度监测的价值。
回顾性分析在阿萨夫·哈罗费医疗中心接受左乙拉西坦治疗并定期随访的50例难治性癫痫患儿的病历。采用高效液相色谱法测定血清左乙拉西坦谷浓度，并与给药剂量和临床报告进行相关性分析。
未发现左乙拉西坦血清水平与临床疗效、耐受性或给药剂量之间存在相关性。左乙拉西坦的平均剂量为43.7±20.0（范围14 - 100）mg/kg/天，平均血清浓度为16.0±9.5（范围2.5 - 38.5）μg/mL。45例（95%）患者癫痫发作频率降低超过50%，其中22例（44%）患者至少6个月无癫痫发作。15例（30%）患者报告了与左乙拉西坦相关的不良事件。未发现血清浓度与不良事件之间存在相关性。这些结果不受性别、年龄、癫痫发作类型和其他药物的影响。
并非所有接受左乙拉西坦治疗的儿童都需要测定血清浓度。血清浓度对于难治性癫痫患者的依从性评估或癫痫发作得到满意控制的患者确定治疗基线可能有价值。
Zotero 插件