Thoughts on levetiracetam (Keppra) dosing for epilepsy?

[enduroevo]

Hello everyone,

Curious about your thoughts on something for those who have prescribed levetiracetam. Have any of you tried using the “pulse” dosing method (described here), which involves only using the medication at a higher dose immediately following and in the 48 hours after an epileptic seizure, rather than prescribing it to be used daily and continuously over time?

If you have used this method, two questions for you:

1. Did you find it to be as effective for preventing seizures as compared to using the medication daily?
2. Did you find it allowed the medication to extend its effectiveness over the long term (eg, was the medication still effective after 6 months to several years)?

I ask these questions because some clinical trial data have shown that Keppra loses its effectiveness after 6 months or so of consistent daily use. Some research has shown that using the pulse method may extend its effectiveness over time.

Curious if any of you have tried this alone, as monotherapy?

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[JaynaAli]

I don’t think we’re supposed to discuss medical/veterinary advice on SDN?

If you’re a pet owner, I’d recommend talking to your veterinarian or seeking referral to a neurologist to discuss your concerns. If you happen to be a pharmacist, I’d talk to the veterinarians who prescribe the medications over random people on an Internet forum.

My only comments regarding the paper you cite is that the patient demographic that presents for referral veterinary care for seizures and gets written about is often more severe, more complex cases that people are having difficulty managing. So while studies like this are important, things may be different in that patient set compared to “average” seizure dogs in general practice. You have to critically evaluate study design and see if you think their conclusions are valid and applicable. Their study states that >90% were receiving other AEDs and there’s a whole section about dogs that had even more drugs added in, so I don’t think they’re advocating for monotherapy.

 

[battie]

I ask these questions because some clinical trial data have shown that Keppra loses its effectiveness after 6 months or so of consistent daily use. Some research has shown that using the pulse method may extend its effectiveness over time.

Is this a human vs veterinary study to begin with?

Regardless, why would we wait for them to have seizures at all, rather than try to actively prevent them?

 

[supershorty]

I don’t think we’re supposed to discuss medical/veterinary advice on SDN?

We have reviewed this post and as it currently is written, it is not requesting medical advice.

My only comments regarding the paper you cite is that the patient demographic that presents for referral veterinary care for seizures and gets written about is often more severe, more complex cases that people are having difficulty managing. So while studies like this are important, things may be different in that patient set compared to “average” seizure dogs in general practice. You have to critically evaluate study design and see if you think their conclusions are valid and applicable. Their study states that >90% were receiving other AEDs and there’s a whole section about dogs that had even more drugs added in, so I don’t think they’re advocating for monotherapy.

^^ just retweeting this.

 

[VIN-Foundation]

1. I sometimes use Keppra as initial monotherapy in dogs, mainly because it's well tolerated. The exception is small dogs, because TID dosing is a problem for a lot of clients.

2. I've used keppra as short-term treatment for clusters in dogs on maintenance
therapy with other drugs.

3. The "honeymoon" effect is not unique to Keppra. Many seizure drugs will work for a while and then the seizures return. In dogs that tend to suffer clusters/status, I almost always recommend they be on daily seizure medication.