From the Guidelines
Keppra should not be used as primary prophylaxis for seizures in patients with brain abscess, as the current evidence suggests against its use in this context. The European Society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults conditionally recommend against primary prophylaxis with antiepileptics in patients with brain abscess, based on expert opinion and very low certainty of evidence 1. This recommendation is crucial in minimizing unnecessary medication use and potential side effects, while also considering the risk of seizures in patients with brain abscess.
Some key points to consider in the management of seizures in patients with brain abscess include:
- Seizures are a frequent complication in patients with brain abscess, and new-onset epilepsy is diagnosed in up to one third of survivors 1
- Patients with brain abscess and seizures are more likely to have an unfavourable outcome at discharge, and epilepsy is associated with increased long-term mortality among survivors 1
- Seizures in patients with previous brain abscess are categorized as epilepsy and should be treated accordingly with antiepileptics, but primary prophylaxis is not recommended 1
In terms of treatment, if seizures do occur in patients with brain abscess, antiepileptic medications like Keppra may be considered as part of the treatment plan, but this should be done on a case-by-case basis, taking into account the individual patient's needs and medical history. The typical starting dose for adults is 500 mg twice daily, which can be gradually increased to 1500-3000 mg daily in divided doses, while children's dosing is based on weight. Common side effects include fatigue, dizziness, and behavioral changes, which should be monitored closely, especially when starting treatment or adjusting dosage.
From the Research
Keppra and Abscess Seizure Treatment
- There is no direct evidence in the provided studies that Keppra treats abscess seizures specifically.
- However, Keppra (levetiracetam) is an antiepileptic drug used to treat various types of seizures, including partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures 2, 3, 4, 5.
- The studies suggest that Keppra is effective in controlling seizures in patients with epilepsy, including those with refractory partial-onset seizures and idiopathic generalized epilepsy 2, 3, 4, 5.
- One study mentions the use of levetiracetam in brain tumor patients, who may experience seizures as a complication, but it does not specifically address abscess seizures 6.
- The mechanism of action of Keppra involves binding to synaptic vesicle protein 2A, inhibiting calcium release, and opposing the activity of negative modulators of GABA- and glycin-gated currents, which may be relevant to treating seizures in general 2, 4, 5.