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Keppra is a newer
anticonvulsant levetiracetam that I have found useful in the
treatment of headache patients.
Keppra (levetiracetam) is a novel antiepileptic drug with a
wide therapeutic index. It appears to moderately inhibit the
delayed-rectifier K+ current. and reduces
high-voltage-activated Ca2+ currents. It also
inhibits negative allosteric modulators (zinc and
ß-carbolines at GABAA
and glycine receptors promoting inhibitory neurotransmission.
After analysis of the first 70 patients that I treated we
found a high rate of success ( 50% ) in major headache reduction
in chronic daily headache (CDH) in patients who had been on at
least 3 previous preventive regimens including other
anticonvulsants such as Depakote and Topamax. We also
found a high drop out rate due to drowsiness. We then
changed our titration regimen. We had previously (starting in
May 2001) begun with 1/2 of the 500 mg pill twice per day.
We have found this is too rapid. We now increase by just
250 mg/week initially to a level of 1500 mg/day in two divided
doses. If there is some improvement, but not a
satisfactory level, we will increase further, again gradually (
250 mg/week) to a total daily dose of 3000 mg. Depending
upon the insurance plan some patients have found it more
economical to switch to the 750 mg pill size: two bid. This is information is so new that it must be regarded
as entirely anecdotal at this point. My experience is completely
open label and uncontrolled. The results of a large
placebo controlled trial is still to be released and we are in the process of an independent
analysis of the 100 patients serially started on levetiracetam
since May 2001 when I discussed the use of the drug with Dr.
Neil Raskin at the American Academy of Neurology meeting during
our opening night course on headache. Since that time I
attended a UCB-Pharma meeting in Boston, MA (October 19, 2001)
and presented two of my patients who had responded very well to
Keppra.
I have continued to use Keppra both in CDH and have started a
number of patients with episodic migraine with and without aura
as an initial preventive regimen. I have applied for an
investigator initiated trial to use as an initial treatment for
episodic migraine as a first drug. The protocol is
awaiting IRB approval January 2003. Update: The
protocol was approved and the study has been started: Over 50
patients have been screened and 20+ have been entered.
This is an early treatment protocol - with the patient having
not tried more than one other preventive anticonvulsant therapy.
Keppra Preliminary Results
Poster for Diamond Headache Meeting, Rancho Mirage, California, February
2003
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