Authors :
Umair Hamid, MD – University of Illinois College of Medicine at Peoria
Presenting Author: Uzair Hamid, MD – University of Illinois College of Medicine at Peoria
Faryal Umair, MBBS – DOW Medical College
Charles Saad, MD – University of Illinois College of Medicine at Peoria
Tiffani Franada, DO – University of Illinois College of Medicine at Peoria
Rationale: Role of pyridoxine in ameliorating psychiatric side effects from Levetiracetam (LEV) has been only recently studied in last decade. Levetiracetam (LEV) is one of the most commonly used anti-seizure medication (ASM) for generalized and focal epilepsy across the world [1]. One of the most common side effect is psychiatric and behavioral adverse effects (PBAs) which is also the most common reason for medication discontinuation [2]. Although, there are studies done in pediatric populations but none in adult populations that study the role of B6 to treat such side effects related to LEV [3-8].
Methods: Our poster will discuss the available evidence demonstrating the utilization of vitamin B6 to treat LEV induced PBAs in adult. We reviewed multiple papers to review using Pubmed and google scholar and found 3 prospective studies, 1 retrospective study and 1 systematic analysis that looked into. After completion of our literature review, we have initiated a retrospective study which has been approved by our institutional IRB to study the improvement in PBAs from LEV in our institution when using vitamin B6 in comparison to the PBAs from LEV without B6 published by FDA [9].
Results:
- Our literature review has resulted with multiple publications that review the B6 role in LEV induced PBA and the rationale behind it.
- In 2008, a study assessed 42 pediatric patients retrospectively by sending them questionnaires who were on LEV and B6. The study suggested possible efficacy of B6 supplementation in the LEV induced PBA.9
- A retrospective study in 2015 showed B6 might be an effective option across all ages of patients suffering from LEV-induced PBAs.12
- A prospective case control without placebo in 50 pediatric patients found 76% vs 8% (not taking B6 vs taking B6) of patients discontinued LEV.13
- In 2021, homeopathic dosing for pyridoxine was used as placebo to compare placebo vs regular dose pyridoxine and found reversal of PBA in regular B6 group. It was a double blinded study with 105 pediatric patients.14
- Lob et al. in 2022 observed improvement in PBA in their retrospective cohort study of 240 pediatric patients.16
- Only study in adults is a retrospective cross-sectional study of 26 male veterans showing subjective improvement after starting B6. No clinical trials have been performed to this date in the adult population.18
Conclusions:
- Based on weak evidence B6 has role in improvement in LEV induced PBAs in adults.
- B6 at higher doses >500mg has potential to cause side effects like sensory neuronopathies but rare with doses < 200 mg.
- Milder PBAs can be managed by providers by adding B6 at doses of 50-100 mg daily with a close follow-up (1-2 weeks) to treat PBAs from LEV
- This review has led us to initiate our retrospective analysis at our center. We are currently studying the prevalence of LEV discontinuation or dose reduction rate in cohort of patients who had received B6. Our primary outcome is to compare LEV discontinuation rate without B6 (as described by FDA) (IRBNET ID2166083-2).
Funding: None