Keppra

Seizure Control

Keppra is an anticonvulsant medication used to manage and prevent seizures. It works by helping to stabilize electrical activity in the brain. While it helps control seizure activity, it does not cure epilepsy and is typically taken long-term as part of a treatment plan.

Types of Seizures Treated

• Partial Onset Seizures: Keppra is used to treat partial onset seizures in adults and children. The immediate-release version can be used for infants as young as 1 month old, while the extended-release version is typically prescribed for patients 12 years of age and older. It may be used alone or in combination with other seizure medications.
• Myoclonic Seizures: This medication is used as an add-on therapy for adults and children 12 years of age and older who have juvenile myoclonic epilepsy.
• Primary Generalized Tonic-Clonic Seizures: Keppra is used as an add-on treatment for adults and children 6 years of age and older who have idiopathic generalized epilepsy.

Keppra is available in several forms, including immediate-release tablets, extended-release tablets, and oral solutions. It is also available as an injection for use in clinical settings when oral administration is temporarily not possible.

Mechanism of Action

Keppra belongs to a class of drugs known as anticonvulsants or antiepileptics. It acts on the central nervous system to reduce the frequency and severity of seizures.

The precise way that Keppra works is not fully understood, but it is known to function differently than many other seizure medications. Research indicates that it binds to a specific protein in the brain called synaptic vesicle protein 2A (SV2A).

By interacting with this protein, Keppra is believed to:

• Help regulate the release of neurotransmitters, which are chemical messengers that allow nerve cells to communicate.
• Decrease abnormal electrical excitement or "bursts" in the brain that lead to seizures.
• Stabilize electrical activity in the brain without interfering with normal nerve cell communication.

Because it targets the SV2A protein, Keppra provides a unique method of seizure control compared to older medications that typically target different pathways, such as sodium channels or GABA receptors.

Common Side Effects

Many people using Keppra experience mild side effects as their body adjusts to the medication. These may include:

• Drowsiness or extreme tiredness
• Dizziness
• Weakness
• Headache
• Loss of appetite
• Stuffy nose or sore throat
• Irritability or nervousness

Serious Side Effects

Contact a healthcare provider immediately if you experience any of the following serious symptoms:

• Mood or behavior changes, such as new or worsening depression, anxiety, panic attacks, or agitation
• Suicidal thoughts or actions
• Aggression, hostility, or loss of emotional control
• Severe coordination problems or difficulty walking
• Signs of a serious skin reaction, such as a rash, blisters, or peeling skin
• Fever, swollen glands, or flu-like symptoms that do not go away
• Confusion or hallucinations

Rare but serious skin reactions, such as Stevens-Johnson syndrome (SJS) or Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), can occur. These conditions require immediate medical attention and may start with a rash, fever, or swollen lymph nodes.

Behavioral and Psychiatric Risks

Keppra may cause behavioral abnormalities and psychotic symptoms. These can include aggression, agitation, anger, anxiety, apathy, depression, and irritability. In some cases, patients may experience hallucinations or delusions.

Suicidal Thoughts and Behavior: Like other antiseizure medications, Keppra may increase the risk of suicidal thoughts or actions. This risk can appear as early as one week after starting the medication. Healthcare providers typically monitor patients for any new or worsening symptoms of depression or unusual changes in mood.

Serious Skin and Systemic Reactions

Rare but life-threatening skin reactions have been reported, including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Additionally, a serious condition called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) can occur. DRESS may start as a rash but can affect internal organs like the liver, kidneys, or lungs.

Central Nervous System Effects

Keppra commonly causes somnolence (extreme sleepiness) and fatigue. It may also cause coordination problems, such as dizziness, vertigo, or difficulty walking (ataxia). These effects are most common during the first four weeks of treatment.

Withdrawal and Seizure Frequency

Antiseizure medications should not be stopped abruptly. Doing so can increase the frequency of seizures or lead to status epilepticus, a life-threatening condition of prolonged seizures. If the medication must be discontinued, it is usually done gradually under medical supervision.

Blood Count Abnormalities

Some patients may experience a decrease in red blood cell counts, white blood cell counts, or neutrophils. While these changes are usually not severe, they may require monitoring through blood tests.

Kidney Impairment

Because Keppra is cleared from the body through the kidneys, individuals with kidney disease may require dosage adjustments. Healthcare providers typically assess kidney function before and during treatment.

Pregnancy

If you are pregnant or planning to become pregnant, discuss the risks and benefits of using Keppra with your healthcare provider. It is generally recommended to use this medication during pregnancy only when the potential benefit justifies the potential risk to the fetus.

Physiological changes during pregnancy can cause the concentration of levetiracetam in the blood to decrease. Healthcare providers often monitor these levels closely throughout pregnancy to ensure the dose remains effective. It is important not to start or stop taking seizure medication without medical advice, as uncontrolled seizures can be harmful to both the pregnant person and the baby.

Patients are encouraged to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry if they become pregnant while taking Keppra. This registry helps track the safety of seizure medications during pregnancy.

Breastfeeding

Levetiracetam is excreted in human breast milk. When deciding whether to breastfeed while taking this medication, healthcare providers consider the importance of the drug to the mother and the potential risks to the infant. It is important to monitor a breastfed infant for any unusual symptoms or changes in behavior.

Oral Formulations

Keppra is primarily administered by mouth and comes in the following oral forms:

• Immediate-release tablets: These are standard tablets taken multiple times per day.
• Extended-release tablets: Known as Keppra XR, these tablets release the medication slowly over time and are typically taken once daily.
• Oral solution: A liquid form of the medication, which is often used for children or individuals who have difficulty swallowing tablets.

Injectable Formulations

For patients who are temporarily unable to take medication by mouth, Keppra is available as an injection:

• Intravenous injection: This form is administered by a healthcare professional directly into a vein.

FDA Approval and Indications

Keppra (levetiracetam) was first approved by the U.S. Food and Drug Administration (FDA) in 1999. It is currently approved for the treatment of several types of seizures, including:

• Partial onset seizures in patients 1 month of age and older.
• Myoclonic seizures in patients 12 years of age and older with juvenile myoclonic epilepsy.
• Primary generalized tonic-clonic seizures in patients 6 years of age and older with idiopathic generalized epilepsy.

Safety Communications

In November 2023, the FDA issued a safety communication regarding a rare but serious drug reaction associated with levetiracetam called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). DRESS is a hypersensitivity reaction that may begin as a rash but can quickly progress to cause injury to internal organs, such as the liver, kidneys, or lungs. The FDA requires a warning about this risk to be included in the prescribing information for all levetiracetam products.

Regulatory Classification

Keppra is available only by prescription. It is not a controlled substance. While it does not have a boxed warning, the FDA requires the medication to be dispensed with a Medication Guide that explains the risks of suicidal thoughts and behaviors, which is a warning common to all antiseizure medications.

Risks of Sudden Discontinuation

You should not stop taking Keppra abruptly without consulting your doctor. Stopping the medication suddenly can lead to several risks, including:

• Increased Seizure Frequency: Your seizures may return or happen more often than before.
• Status Epilepticus: This is a serious, life-threatening condition where seizures do not stop or occur in rapid succession without recovery in between.

Gradual Tapering

To safely discontinue Keppra, healthcare providers typically recommend a gradual reduction in dosage. This tapering process helps minimize the risk of withdrawal-related seizures. Your doctor will provide a specific schedule to slowly lower the dose over time.

Even if you experience side effects, such as changes in mood or behavior, do not stop the medication until you have spoken with a medical professional to determine the safest way to proceed.