The Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA.
Stanford Medical School, 291 Campus Dr, Stanford, CA 94305, USA.
Epilepsy Behav. 2022 Sep;134:108839. doi: 10.1016/j.yebeh.2022.108839. Epub 2022 Jul 12.
Levetiracetam (LEV) is an anti-seizure medication (ASM) known to have significant behavioral side effects in children with epilepsy. These side effects may be improved by supplemental vitamin B6 (pyridoxine) use. Our research aimed to study risk factors for LEV side effects and the role of vitamin B6 in altering this risk.
We retrospectively analyzed the demographic and clinical profile of all pediatric patients on LEV treatment between July 2019 and December 2020. T-tests, Chi-square and Fisher exact tests were used to assess predictors of LEV discontinuation. A p-value of <0.05 was considered statistically significant.
150/240 (62%) children were on additional medications besides LEV for epilepsy management. Thirty-five percent children reported side effects, especially behavioral and mood concerns. Of the patients who reported side effects on LEV, 71% were taking vitamin B6 (n = 59). The rate of LEV discontinuation was significantly lower for children on vitamin B6 than children not taking B6, regardless of monotherapy or polypharmacy (49% v 88% respectively, p = 0.001). Over half of the patients who were able to remain on LEV reported improved behavior with B6 supplementation as compared to those who were unable to continue LEV (17/30, 57% versus 0/26, 0%; p < 0.001).
Levetiracetam side effects significantly impact the tolerability of this ASM in children with epilepsy. Our results suggest that vitamin B6 supplementation can significantly reduce the odds of discontinuing LEV due to its behavioral side effects.
左乙拉西坦（LEV）是一种抗癫痫药物（ASM），已知其在患有癫痫的儿童中具有显著的行为副作用。这些副作用可以通过补充维生素 B6（吡哆醇）来改善。我们的研究旨在研究 LEV 副作用的危险因素以及维生素 B6 改变这种风险的作用。
我们回顾性分析了 2019 年 7 月至 2020 年 12 月期间所有接受 LEV 治疗的儿科患者的人口统计学和临床特征。使用 t 检验、卡方检验和 Fisher 确切检验来评估 LEV 停药的预测因素。p 值<0.05 被认为具有统计学意义。
150/240（62%）名儿童除了 LEV 外还服用其他药物来治疗癫痫。35%的儿童报告有副作用，特别是行为和情绪问题。在报告 LEV 副作用的患者中，71%（n=59）正在服用维生素 B6。与未服用 B6 的患者相比，服用维生素 B6 的患者 LEV 停药率明显较低，无论是否为单药治疗或多药治疗（分别为 49%和 88%，p=0.001）。与无法继续服用 LEV 的患者相比，能够继续服用 LEV 的患者中有一半以上报告补充 B6 后行为得到改善（17/30，57%与 0/26，0%；p<0.001）。
LEV 的副作用显著影响了这种 ASM 在患有癫痫的儿童中的耐受性。我们的结果表明，维生素 B6 补充剂可以显著降低因行为副作用而停止使用 LEV 的几率。
