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Anti-Epileptic Drug Levetiracetam May Relieve Pain With Minimal Side Effects
A DGReview of :"Levetiracetam in the treatment of neuropathic pain: three case studies"
Clinical Journal of Pain
12/30/2003
By Emma Hitt, PhD
Levetiracetam, a new antiepileptic drug, appears to be effective in treating neuropathic pain, according to an analysis of 3 case studies.
The pharmacologic therapy for neuropathic pain using traditional pain treatments or analgesic drugs is often unsuccessful. Levetiracetam (Keppra, UCB Pharma, Inc.) has a favourable side-effect profile and does not interact with other drugs. Similarities in the pathophysiology and biochemistry of neuropathic pain and epilepsy, has led to the use of this drug class in these conditions.
In his report, Michael J. Price, MD, with the Wuesthoff Memorial Hospital, Rockledge, Florida, United States, describes the outcome of 3 patients treated in his office.
One patient, a 55-year-old woman, presented with numbness and pain in both lower extremities. The pain was of sudden onset and of 4 months' duration, and was determined to be peripheral neuropathy with mild axonal and demyelinating features.
Initial treatment with oral thiamine and topiramate provided minimal benefits and caused unacceptable adverse effects. The woman was switched to 1500 mg twice a day of levetiracetam plus nortriptyline, and this resulted in a 60% improvement in pain symptoms.
The second case was a 75-year-old man, who presented with numbness in both feet beginning 5 years earlier. The numbness had progressed to persistent pain, resulting in sleep disruption. Oral thiamine did not relieve the pain; however, 500 mg levetiracetam once in the evening completely resolved his pain and improved his sleep.
The third case involved a 67-year-old obese male with progressive dysfunction in both lower extremities that developed over a 1-year period. Walking caused pain that disrupted sleep at night. Treatment with 1000 mg levetiracetam twice a day completely resolved the pain.
According to Dr. Price, levetiracetam appears to be an effective therapy in the treatment of neuropathic pain, causing a low incidence of adverse events and improving patients' sleep.
"Over time these benefits appear to have been sustained," the author notes, and "controlled clinical trials would be warranted to support the findings obtained in these studies," he adds.
Clin J Pain. 2004;20:33-36.
"Levetiracetam in the treatment of neuropathic pain: three case studies"
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