From the Research
Levetiracetam (Keppra) is generally considered safe for patients with Brugada syndrome, as it does not significantly affect cardiac conduction due to its unique mechanism of action. Unlike many other antiepileptic medications that can block sodium channels and potentially worsen Brugada syndrome, Keppra works through a different mechanism by binding to synaptic vesicle protein SV2A. For patients with both epilepsy and Brugada syndrome, Keppra is often prescribed at standard doses (typically starting at 500 mg twice daily for adults, with potential increases up to 1500 mg twice daily based on response and tolerability) 1.
When treating a patient with Brugada syndrome who requires antiepileptic medication, it's essential to avoid sodium channel blockers like carbamazepine, phenytoin, and lamotrigine, as these can potentially trigger Brugada ECG pattern or arrhythmias. Regular cardiac monitoring may still be advisable when initiating Keppra therapy in these patients, although the risk of cardiac adverse effects is low. If a patient with Brugada syndrome experiences any new cardiac symptoms while on Keppra, such as palpitations, syncope, or chest pain, they should seek immediate medical attention. The most recent study on Brugada syndrome, published in 2024, highlights the importance of repeated ECG evaluation and high precordial lead ambulatory monitoring in identifying transient type 1 Brugada pattern and its associated risk 1.
Key considerations for managing patients with Brugada syndrome include:
- Avoiding sodium channel blockers
- Regular cardiac monitoring
- Initiating Keppra therapy at standard doses
- Monitoring for new cardiac symptoms
- Considering repeated ECG evaluation and high precordial lead ambulatory monitoring to identify transient type 1 Brugada pattern.
Overall, Keppra is a suitable option for patients with Brugada syndrome who require antiepileptic medication, due to its unique mechanism of action and low risk of cardiac adverse effects 2, 3.