Impact of Levetiracetam Therapy on Seizure Control and Cognitive Outcomes in Children with Epilepsy

Abstract

Objective: Levetiracetam (LEV) is effective in seizure control and has a full spectrum of effects on cognitive development, neuropsychological, and behavioral outcomes in children with newly diagnosed epilepsy over 12 months.

Material and Methods: A prospective, multicenter, longitudinal, observational, cohort study was designed. Five tertiary epilepsy centres in Pakistan. Baseline and 6- and 12-month cognitive and behavioral assessments included the Wechsler Intelligence Scale for Children (WISC-V), the Neuropsychological Assessment, and the Child Behavior Checklist (CBCL). In addition, serum LEV trough concentrations and SV2A polymorphisms were evaluated.

Results: 342 patients were enrolled, with 310 patients having completed the 12-month follow-up. By 12 months, 74.2% of patients had ≥50% of their seizures reduced and 58.4% became seizure-free. Cognitive testing demonstrated an average or enhanced full-scale IQ and certain domains of cognition (p < 0.05). Behavioral assessments did, however, show statistically significant elevations of externalizing behavior from the CBCL (p > 0.05), with higher serum LEV levels and faster titration rates being correlated.

Conclusion: Levetiracetam is well-established as a very effective agent for the control of pediatric epilepsy and has a favorable cognitive-sparing profile. But it has a high risk of behavioral side effects, especially behaviors that are externalized. Routine behavioral monitoring with careful titration iskey to optimizing therapeutic outcomes.