Recommended Dosage of Levetiracetam for Juvenile Myoclonic Seizures
The recommended dosage of levetiracetam for juvenile myoclonic epilepsy is 20-60 mg/kg/day in two divided doses, with a typical target dose of 3000 mg/day for adolescents and adults. 1, 2
Initial Dosing and Titration
- For patients 12 years and older with juvenile myoclonic epilepsy, treatment should be initiated with 1000 mg/day (500 mg twice daily) and increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg 1
- For pediatric patients under 12 years, treatment should start with 20 mg/kg/day divided into two doses (10 mg/kg twice daily) 1
- Titration should increase by 20 mg/kg every 2 weeks up to the recommended daily dose of 60 mg/kg/day (30 mg/kg twice daily) 1
- The effectiveness of doses lower than 3000 mg/day in adolescents and adults has not been adequately studied 1
Weight-Based Dosing Guidelines
- Patients weighing ≤20 kg should be dosed with oral solution 1
- Patients weighing >20 kg can be dosed with either tablets or oral solution 1
- For patients 20.1-40 kg: 500 mg/day initially (250 mg twice daily), titrating to 1500 mg/day (750 mg twice daily) 1
- For patients >40 kg: 1000 mg/day initially (500 mg twice daily), titrating to 3000 mg/day (1500 mg twice daily) 1
Clinical Evidence for Efficacy
- In clinical studies, levetiracetam has shown effectiveness as both monotherapy and add-on therapy for juvenile myoclonic epilepsy 3, 4
- An open-label study found that 28.9% of patients with add-on levetiracetam treatment and 50% of newly diagnosed patients became seizure-free for a mean period of 17.2 months 3
- Another study reported 80% of patients with juvenile myoclonic epilepsy became seizure-free with levetiracetam monotherapy 4
- The mean dose used in clinical practice was approximately 2208 mg/day, though doses ranged from 1000-3000 mg/day 3
Special Considerations
- Dosing must be individualized according to renal function in adult patients 1
- Levetiracetam can be administered with or without food 1
- Behavioral changes and psychotic reactions may occur more frequently in younger patients (under 4 years), typically during the titration phase and often at lower dosages (<20 mg/kg/day) 5
- For status epilepticus protocols, higher loading doses of 40 mg/kg (maximum 2,500 mg) may be used 2
- Some studies have shown efficacy with lower doses (20-25 mg/kg/day) when used in combination therapy 6