From the Guidelines
Keppra (levetiracetam) is not typically considered a first-line treatment for absence seizures. While there is evidence that Keppra can be effective in treating certain types of seizures, such as status epilepticus, as shown in a study published in the Annals of Emergency Medicine 1, it is not specifically indicated for absence seizures. The study found that levetiracetam had a similar efficacy to valproate in stopping seizures, with 73% of patients experiencing seizure cessation after infusion. However, this study focused on status epilepticus, not absence seizures.
When considering treatment for absence seizures, medications like ethosuximide, valproic acid, and lamotrigine are generally preferred. Ethosuximide is usually the first choice for children with absence seizures alone, while valproic acid may be used when absence seizures occur alongside other seizure types. Keppra works by binding to a synaptic vesicle protein called SV2A, which helps regulate neurotransmitter release, but this mechanism doesn't target the specific thalamic circuits involved in absence seizures as effectively as other medications.
Some key points to consider when treating absence seizures include:
- The choice of medication depends on the patient's specific situation and the type of seizures they are experiencing
- Combination therapy may be necessary in some cases
- Medication changes should always be discussed with a neurologist who can provide personalized recommendations
- The most recent and highest quality studies should be consulted when making treatment decisions, but in this case, the evidence is not directly applicable to absence seizures.
It's worth noting that the study published in the Annals of Emergency Medicine 1 provides valuable information on the use of levetiracetam in status epilepticus, but it does not provide direct evidence for its use in absence seizures. Therefore, the decision to use Keppra for absence seizures should be made with caution and in consultation with a neurologist.
From the Research
Treatment of Absence Seizures
- The provided studies do not mention Keppra (levetiracetam) as a primary treatment for absence seizures, but one study 2 discusses its clinical use and efficacy for absence epilepsies.
- According to the study 2, levetiracetam is often prescribed for patients with absence seizures, but only about one-quarter of children with absence epilepsy became seizure free with levetiracetam.
- The study 2 also found that when effective, levetiracetam can control absence epilepsy at a relatively low dose, and lack of seizure control requiring continued dose escalation should prompt early consideration of a therapeutic medication transition.
Alternative Treatments for Absence Seizures
- The studies 3, 4, 5, 6 discuss the use of ethosuximide, sodium valproate, and lamotrigine for the treatment of absence seizures in children and adolescents.
- These studies suggest that ethosuximide and valproate are more effective than lamotrigine as initial monotherapy for children with childhood absence epilepsy 3, 4.
- However, the studies also note that the evidence is limited by the small number of trials and their poor methodological quality, and more trials of better quality are needed to inform clinical practice 3, 4, 5, 6.