From the Guidelines
You should consult your neurologist promptly to adjust your seizure treatment plan, as the current Keppra dose is not providing adequate control over your seizures. Since you're experiencing breakthrough seizures despite taking Keppra (levetiracetam) 750mg twice daily, your doctor may need to increase your Keppra dose or add a second antiepileptic medication, such as valproate, as suggested by the recent clinical policy 1. Your neurologist might also order an EEG to better understand your seizure patterns and possibly brain imaging if not recently done. Some key points to consider when adjusting your treatment plan include:
- Keeping a detailed seizure diary noting the frequency, duration, and circumstances of your episodes to help your doctor make informed decisions
- Avoiding seizure triggers like alcohol, sleep deprivation, and excessive stress
- Ensuring those around you know seizure first aid
- Never adjusting your medication without medical supervision as this could worsen your condition It's also important to note that breakthrough seizures often occur because the current medication dose isn't providing adequate coverage for your specific seizure type or because the underlying cause needs further investigation, as highlighted in the clinical policy 1.
From the Research
Next Steps for Unprovoked Seizures
Given the patient's history of unprovoked seizures 3 times in the past 6 months while on Keppra 750mg BID, the following options can be considered:
- Adjusting the current medication: The patient is already on a relatively high dose of Keppra. However, 2 suggests that higher doses (750-1,000 mg bid) may be more effective in achieving target serum levels and reducing seizure odds.
- Adding a new medication: Considering the patient's ongoing seizures, adding a new antiepileptic drug may be necessary. 3 provides preclinical data on pharmacodynamic interactions between antiepileptic drugs, suggesting potential synergies between certain combinations, such as valproate + phenytoin, lamotrigine + valproate, or levetiracetam + topiramate.
- Switching to a different medication: If the patient's seizures are not adequately controlled on Keppra, switching to a different antiepileptic drug may be considered. 4 compares the efficacy of various antiepileptic drugs for generalized epileptic seizures, suggesting that lamotrigine, levetiracetam, and topiramate may be as effective as valproate.
- Consulting a specialist: Given the complexity of the patient's condition, consulting a neurologist or epileptologist may be beneficial to determine the best course of action.
Key Considerations
When making decisions about the patient's treatment, the following factors should be considered:
- Efficacy of the current medication: The patient's ongoing seizures suggest that the current medication may not be effective enough.
- Potential side effects: Any changes to the patient's medication regimen should take into account potential side effects and interactions with other medications.
- Patient characteristics: The patient's age, medical history, and other factors should be considered when selecting a new medication or adjusting the current regimen.
- Cost-effectiveness: The cost-effectiveness of different treatment options should be considered, as some medications may be more expensive than others 5.