Levetiracetam monotherapy appears to be an effective strategy for controlling seizures in pregnancy, results from a large Australian study demonstrated.
In fact, levetiracetam provided seizure control comparable with that of older antiepileptic drugs (AEDs) carbamazepine and valproate but superior when compared with other newer AEDs, including lamotrigine and topiramate. The findings suggest that levetiracetam can be considered "among the agents of first choice in women contemplating pregnancy, and to be suitable for use in most circumstances in women who have the potential for pregnancy, unless the type of seizure disorder present, or other consideration, makes a different agent clinically preferable," wrote Dr. Frank J. E. Vajda of the department of medicine at the University of Melbourne and his associates (Epilepsia 2014 July 3 [doi:10.1111/epi.12711]).
Using a national registry, the researchers analyzed data regarding seizure control in 1,111 pregnancies that began between the middle of 1998 and November of 2013, during which the patients took only one AED for at least the first trimester. The seizure occurrence rates for patients on levetiracetam monotherapy were 31.7% for any seizure and 13.4% for convulsive seizures, which were similar to the rates of all older AEDs combined (34.8% and 18.9%, respectively). Compared with levetiracetam, however, the rate of seizure-affected pregnancy was about 50% and 30% higher among patients on lamotrigine and topiramate, respectively.
The authors acknowledged certain limitations of the study, including the fact that the allocation of particular AEDs "was not randomized, and there can be no guarantee that the drugs were always taken as prescribed or necessarily employed optimally, guided by plasma AED concentration monitoring when that was available."
The researchers stated that they had no relevant financial conflicts.