From the Guidelines
After administering a loading dose of Keppra (levetiracetam) for a child with new onset seizure, you should start daily maintenance treatment. The maintenance dosing typically begins 12 hours after the loading dose, with a recommended maintenance dose of 10-60 mg/kg/day divided into two equal doses given every 12 hours 1. For children, the specific dose depends on the child's age, weight, and clinical response. Some key points to consider when initiating daily treatment include:
- The anticonvulsant effect of the loading dose is temporary, and without continued treatment, seizures are likely to recur as drug levels decline 1.
- Levetiracetam works by binding to the synaptic vesicle protein SV2A in the brain, modulating neurotransmitter release and helping to prevent the abnormal electrical activity that causes seizures.
- Regular monitoring of the child's response to therapy, including seizure frequency and any adverse effects, is important for optimizing treatment. The study by 1 provides information on the loading dose and route of administration strategies for antiepileptic medications, including levetiracetam, which supports the decision to start daily maintenance treatment after a loading dose. Key considerations for the maintenance dose include:
- Starting with a dose of 20 mg/kg/day divided into two doses, which can be titrated up as needed based on seizure control and tolerability.
- Monitoring for adverse effects, such as fatigue, dizziness, and pain at the infusion site, which are rarely reported with levetiracetam 1.
From the FDA Drug Label
Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID). The daily dose should be increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID).
After administering a loading dose of Keppra for a child with new onset seizure, yes, you start daily treatment. The daily dose should be initiated with 20 mg/kg in 2 divided doses, and then increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg 2.
From the Research
Administration of Daily Treatment after Loading Dose of Keppra
After administering a loading dose of Keppra (levetiracetam) for a child with new onset seizure, the decision to start daily treatment depends on various factors, including the type of seizure, the child's medical history, and the presence of any underlying conditions.
Factors Influencing Daily Treatment
- The risk of a second seizure is about 36% at 2 years and 46% after 5 years, as reported in 3.
- The presence of EEG epileptiform discharges, a brain imaging abnormality, a nocturnal first seizure, or prior brain trauma can double the risk of a second seizure, as noted in 3.
- Levetiracetam is considered an effective treatment option for generalized tonic-clonic, tonic, and clonic seizures, with a probability of presenting the outcome "Seizure free" of 47%, as shown in 4.
Treatment Options
- Levetiracetam, lamotrigine, and topiramate are as effective as valproate for treating generalized tonic-clonic, tonic, and clonic seizures, according to 4.
- Levetiracetam can be a good alternative to sodium valproate, especially in women of childbearing age, as suggested in 5.
- The Swedish practice guidelines for monotherapy in epilepsy recommend carbamazepine, lamotrigine, or levetiracetam for children and adults with seizures with focal onset, as stated in 6.
Efficacy and Safety of Levetiracetam
- Levetiracetam has been shown to be effective in stopping status epilepticus and improving the level of consciousness in approximately half of the patients, with a posterior probability of 0.41, as reported in 7.
- The incidence of adverse events associated with levetiracetam is similar to that of fosphenytoin and valproate, as noted in 7.