From the Guidelines
Levetiracetam is the most suitable first-line antiseizure medication for a semi-compliant teenager with a history of drug use. This recommendation is based on its minimal drug interactions, which is crucial for individuals with potential substance use issues 1. The typical starting dose is 500 mg twice daily, which can be titrated up to 1000-1500 mg twice daily based on seizure control and tolerability.
Key Considerations
- Levetiracetam has a relatively favorable side effect profile compared to older antiepileptic drugs, although mood changes and irritability should be monitored, especially in adolescents.
- The medication's twice-daily dosing schedule may help with compliance issues, and its relatively long half-life provides some forgiveness for occasionally missed doses.
- Levetiracetam does not require blood level monitoring and has a low risk of hepatotoxicity, which is beneficial for patients who may not be reliable with follow-up appointments.
Alternative Options
- Alternative options could include lamotrigine or oxcarbazepine, but these require more careful titration or may have more significant interaction concerns with substances of abuse.
- It is essential to consider the individual patient's needs and circumstances when selecting an antiseizure medication, taking into account factors such as substance use history, compliance, and potential drug interactions 1.
From the FDA Drug Label
A total of 5.0% of levetiracetam-treated patients had a reduction in dose or discontinued treatment due to behavioral or psychiatric events (reported as anxiety, depressed mood, depression, irritability, and nervousness), compared to 1. 7% of placebo patients. Non-psychotic behavioral disorders (reported as aggression and irritability) occurred in 5% of the levetiracetam-treated patients compared to 0% of placebo patients. Non-psychotic mood disorders (reported as depressed mood, depression, and mood swings) occurred in 6. 7% of levetiracetam-treated patients compared to 3.3% of placebo patients.
The ideal antiseizure medication for a semi-compliant teenager who also does drugs is not explicitly stated in the provided drug labels. However, considering the potential for behavioral and psychiatric adverse events associated with levetiracetam, such as irritability, aggression, and depression, it may not be the most suitable option for a teenager with a history of substance use.
- Key considerations for this patient population include:
- Potential for increased risk of behavioral and psychiatric adverse events
- Importance of close monitoring for signs of irritability, aggression, and depression
- Need for alternative treatment options that may be more suitable for a semi-compliant teenager with a history of substance use 2.
From the Research
Suitable Antiseizure Medications
When considering a suitable first-line antiseizure medication for a semi-compliant teenager with a history of drug use, several factors must be taken into account. The goal is to find a medication that is effective in controlling seizures while also being tolerable and minimizing potential interactions with other substances.
Efficacy and Tolerability
- Levetiracetam (LEV) and lamotrigine (LTG) are popular first-choice drugs for epilepsy, as shown in the LaLiMo Trial 3.
- A study comparing LEV, LTG, and sodium valproate in patients with juvenile myoclonic epilepsy found that LEV and sodium valproate have similar efficacy, but LTG had a higher rate of failure in controlling seizures and myoclonic jerks 4.
- Another study found that LEV and LTG have antiepileptogenic-like effects by blocking seizure development during the treatment period 5.
Considerations for Semi-Compliant Teenagers
- LEV may be a good alternative to sodium valproate, especially in women of childbearing age, due to its similar efficacy and lower adverse effects 4.
- A study comparing unique antiepileptic drug regimens in focal epilepsy found that LEV/LTG duotherapy and LTG monotherapy were more effective than other regimens 6.
- LEV has been shown to have a benign neuropsychological side effect profile, making it a cognitively safe drug to use for controlling established seizures in patients with Alzheimer's disease 7.
Potential Interactions with Other Substances
- There is limited information available on the potential interactions between antiseizure medications and recreational drugs.
- However, it is essential to consider the potential risks of drug interactions and to monitor the patient closely for any adverse effects.