From the Guidelines
Keppra should be tapered gradually when discontinuing treatment to minimize the risk of seizures, with a typical taper involving reducing the dose by 500 mg every 2-4 weeks. When considering a Keppra taper, it's essential to prioritize the patient's seizure history, duration of treatment, and current dose to determine the optimal tapering schedule. According to the study published in the Annals of Emergency Medicine 1, there is a lack of evidence to support one route of administration over the other in terms of preventing early recurrent seizure. However, the study does provide information on loading doses and routes of administration for antiepileptic medications, including Keppra.
- Key considerations for a Keppra taper include:
- Reducing the dose by 500 mg every 2-4 weeks
- Individualizing the tapering schedule based on the patient's seizure history and current dose
- Monitoring patients closely for breakthrough seizures or withdrawal symptoms
- Avoiding seizure triggers like sleep deprivation, alcohol consumption, and stress during the tapering process
- The study 1 notes that loading with antiepileptic medication is commonly done, but there is a lack of evidence to support or refute this practice. However, it does provide information on the safety and efficacy of rapid IV loading of Keppra, with doses up to 60 mg/kg being well-tolerated.
- In clinical practice, the goal of a Keppra taper is to minimize the risk of seizures while allowing the patient to safely discontinue the medication. By prioritizing the patient's individual needs and closely monitoring their response to the taper, healthcare providers can help ensure a successful outcome.
From the Research
Keppra Taper Overview
- Keppra, also known as levetiracetam, is an antiepileptic drug used to treat seizures in patients with epilepsy 2, 3, 4.
- The decision to taper Keppra should be made after a full discussion with the patient of risks and benefits, considering population risk factors for seizure recurrence, the patient's lifestyle, and preferences 5.
Tapering Patterns and Seizure Recurrence
- A study found that among patients undergoing antiepileptic drug tapering, seizure recurrence was reported in 29.2% of patients, with a higher recurrence rate in patients taking valproate (35.5%) and levetiracetam (28.8%) 6.
- Parameters having significant association with seizure recurrence included duration of epilepsy, frequency of seizures before control, history of previously failed tapering, and history of smoking/alcoholic/tobacco intake 6.
Levetiracetam Characteristics
- Levetiracetam has a novel structure and unique mechanisms of action, involving neuronal binding to synaptic vesicle protein 2A and inhibiting calcium release from intraneuronal stores 2, 3, 4.
- It is associated with rapid and complete absorption, high oral bioavailability, minimal metabolism, and primarily renal elimination, with a low potential for drug interactions 2, 3, 4.
Tapering Recommendations
- Antiepileptic drugs, including Keppra, are usually discontinued in a slow step-wise fashion, one at a time, after at least two years of remission 5.
- Patients need access to specialist follow-up over the period after discontinuation, as seizure recurrence risk plateaus only after 2 years following antiepileptic drug discontinuation 5.