Skip to main content
PMC home page
American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2010 Mar;25(2):149–154. doi: 10.1177/1533317508325095

Levetiracetam: A Practical Option for Seizure Management in Elderly Patients With Cognitive Impairment

Carol F Lippa 1, Andrea Rosso 2, Marjorie Hepler 3, Sigmund Jenssen 4, Jyoti Pillai 5, David Irwin 6
PMCID: PMC10845688  PMID: 19001351

Abstract

Cognitive impairment and seizures are common in our aging population. Anticonvulsant treatment is problematic due to sedation, cognitive slowing, and behavioral changes. Levetiracetam has favorable pharmacokinetics, good efficacy in elderly individuals, a favorable side effect profile, and lacks major drug interactions. We conducted a prospective, uncontrolled, phase 4, open label, 12-week study of levetiracetam to better profile its efficacy, safety, and impact on cognitive/behavioral status in 24 cognitively impaired, elderly individuals. In total, 69% were seizure free for the duration of the study; the remaining participants had satisfactory seizure control. Fatigue was the most common side effect (5 participants). Significant overall improvements were observed for the Folstein’s Mini-Mental State Examination and the Alzheimer’s Disease Assessment Scale—Cognitive. No significant changes were seen in behavioral or functional measures. Levetiracetam is an effective antiepileptic drug in elderly individuals with cognitive impairment. At 3 months, participants who remained on levetiracetam showed excellent cognitive tolerability.

Keywords: levetiracetam, seizure, epilepsy, dementia, mild cognitive impairment, Alzheimer’s disease

Full Text

The Full Text of this article is available as a PDF (171.2 KB).

Contributor Information

Carol F. Lippa, Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA, clippa@drexelmed.edu .

Andrea Rosso, Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA.

Marjorie Hepler, Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA.

Sigmund Jenssen, Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA.

Jyoti Pillai, Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA.

David Irwin, Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA.

References

  1. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60: 1119-1122. [DOI] [PubMed] [Google Scholar]
  2. Ebly EM, Hogan DB, Parhad IM Cognitive impairment in the nondemented elderly. Results from the Canadian Study of Health and Aging. Arch Neurol. 1995. ;52:612-619. [DOI] [PubMed] [Google Scholar]
  3. Grundman M., Petersen RC, Ferris SH, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol . 2004;61:59-66. [DOI] [PubMed] [Google Scholar]
  4. Ritchie K., Touchon J. Mild cognitive impairment: conceptual basis and current nosological status . Lancet. 2000;355:225-228. [DOI] [PubMed] [Google Scholar]
  5. Petersen RC, Doody R., Kurz A., et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001;58: 1985-1992. [DOI] [PubMed] [Google Scholar]
  6. Mendez M., Lim G. Seizures in elderly patients with dementia: epidemiology and management . Drugs Aging. 1905;20: 791-803. [DOI] [PubMed] [Google Scholar]
  7. Alsaadi TM, Koopmans S., Apperson M., Farias S. Levetiracetam monotherapy for elderly patients with epilepsy. Seizure. 2004;13:58-60. [DOI] [PubMed] [Google Scholar]
  8. Cramer JA, Leppik IE, Rue KD, Edrich P., Kramer G. Tolerability of levetiracetam in elderly patients with CNS disorders . Epilepsy Res. 2003;56:135-145. [DOI] [PubMed] [Google Scholar]
  9. Belcastro V. , Costa C., Galletti F., Pisani F., Calabresi P., Parnetti L. Levetiracetam monotherapy in Alzheimer patients with late-onset seizures: a prospective observational study. Eur J Neurol. 2007;14:1176-1178. [DOI] [PubMed] [Google Scholar]
  10. Patsalos PN Clinical pharmacokinetics of levetiracetam . Clin Pharmacokinet. 1905;43:707-724. [DOI] [PubMed] [Google Scholar]
  11. Patsalos PN The pharmacokinetic characteristics of levetiracetam . Methods Find Exp Clin Pharmacol. 2003;25:123-129. [DOI] [PubMed] [Google Scholar]
  12. Briggs DE, French JA Levetiracetam safety profiles and tolerability in epilepsy patients . Expert Opin Drug Saf. 2004;3:415-424. [DOI] [PubMed] [Google Scholar]
  13. Arroyo S., Crawford P. Safety profile of levetiracetam. Epileptic Disord . 2003;5(suppl 1):S57-S63. [PubMed] [Google Scholar]
  14. French J., Edrich P., Cramer JA A systematic review of the safety profile of levetiracetam: a new antiepileptic drug. Epilepsy Res. 2001;47:77-90. [DOI] [PubMed] [Google Scholar]
  15. Piazzini A. , Chifari R., Canevini MP, Turner K., Fontana SP, Canger R. Levetiracetam: an improvement of attention and of oral fluency in patients with partial epilepsy . Epilepsy Res. 2006;68:181-188. [DOI] [PubMed] [Google Scholar]
  16. Folstein MF , Folstein SE, McHugh PR ‘‘Mini-mental state’’. A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12: 189-198. [DOI] [PubMed] [Google Scholar]
  17. Burch EAJ , Andrews SR Comparison of two cognitive rating scales in medically ill patients. Int J Psychiatry Med. 1987;17:193-200. [DOI] [PubMed] [Google Scholar]
  18. McRae C. , Diem G., Vo A., O’Brien C., Seeberger L. Schwab & England: standardization of administration. Mov Disord. 2000;15:335-336. [DOI] [PubMed] [Google Scholar]
  19. Tariot PN, Mack JL, Patterson MB, et al. The Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for Alzheimer’s Disease. The Behavioral Pathology Committee of the Consortium to Establish a Registry for Alzheimer’s Disease. Am J Psychiatry. 1995;152:1349-1357. [DOI] [PubMed] [Google Scholar]
  20. Miller RJ, Snowdon J., Vaughan R. The use of the Cohen-Mansfield Agitation Inventory in the assessment of behavioral disorders in nursing homes. J Am Geriatr Soc . 1995;43:546-549. [DOI] [PubMed] [Google Scholar]
  21. Jacobson MP Epilepsy in aging populations. Curr Treat Options Neurol. 2002;4:19-30. [DOI] [PubMed] [Google Scholar]
  22. Harms SL, Eberly LE, Garrard JM, Hardie NA, Bland PC, Leppik IE Prevalence of appropriate and problematic antiepileptic combination therapy in older people in the nursing home. J Am Geriatr Soc. 2005;53: 1023-1028. [DOI] [PubMed] [Google Scholar]
  23. Sirven JI, Ozuna J. Diagnosing epilepsy in older adults: what does it mean for the primary care physician? Geriatrics. 2005;60:30-35. [PubMed] [Google Scholar]

Articles from American Journal of Alzheimer's Disease and Other Dementias are provided here courtesy of SAGE Publications

RESOURCES