Analysis of Levetiracetam Side-Effects Leading to Discontinuation of Therapy and Role of Vitamin B6 in Pediatric Epilepsy
Abstract number :
2.236
Submission category :
7. Anti-seizure Medications / 7D. Drug Side Effects
Year :
2021
Submission ID :
1826086
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Karen Lob, BS - Brown University; Julia Bassell, MD - Stanford School of Medicine; Anarina Murillo, PhD - Brown University; Rachit Patil, MD - Brown University; Duyu Nie, MD, PhD - Brown University; Luca Bartolini, MD - Brown University
Rationale: Levetiracetam (LEV) is an anti-seizure medication (ASM) known to have significant behavioral side effects in children with epilepsy, that are often under-reported. Vitamin B6 (pyridoxine) has been anecdotally reported to decrease the risk of side-effects due to LEV use, but data are limited. Aim of this study was to analyze risk factors for LEV side-effects and the role of vitamin B6 in altering this risk.
Methods: We retrospectively analyzed the demographic and clinical profile of all pediatric patients on LEV treatment seen by three pediatric epileptologists between July 2019 and December 2020. Data collected included dose of LEV and B6, side effects, seizure frequency, age of epilepsy onset, epilepsy type and duration, other ASM used, EEG and MRI findings. Associations between Vitamin B6 use and onset of side-effects were evaluated using Chi-square tests. We used logistic regression modeling to assess predictors of side-effects during LEV treatment. Mann-Whitney tests were used to evaluate relationships between LEV dose and side effects.
Results: Of 476 screened pediatric patients with epilepsy, 241 were on LEV (median age 9.7 years), and 83 (34.44%) had side effects. The most common were aggression (24.36%), restlessness/nervousness/agitation (19.27%), self-injurious behavior/suicidal ideation (10.08%), moodiness (9.24%) and depression (8.40%). Of the 83 patients who experienced side effects, 50 (60.24%) discontinued LEV and 8 (9.63%) lowered the LEV dose. The median LEV dose of patients with side effects (37.50 mg/kg/day) did not significantly differ from the median dose of patients without side effects (33.00 mg/kg/day) (p = 0.104). 102/241 (42%) were also on B6. After controlling for sex, race, ethnicity, seizure frequency, age and epilepsy type, patients who used B6 were 6.89 times less likely to report side effects due to LEV compared to patients who did not use Vitamin B6 (p < 0.0001, 95% CI [3.82, 12.40]). Median dose of Vitamin B6 was significantly higher in patients without side effects (3.50 mg/kg/day) as compared to patients with side effects (2.00 mg/kg/day) (p = 0.016).
Anti-seizure Medications