The Epileptic fits are well under control but mild seizures occur in a month or so even after taking Levipil 500 1 Bd. How to prevent it? The dose is less or something else is needed.
Maybe The levetiracetam level should be checked.
Often, the recommended time is just before the next dose is taken (trough level). The therapeutic range for levetiracetam is about 12.0 - 46.0 mcg/mL (mg/L). Levels above 46 mcg/mL are considered potentially toxic. Ranges vary slightly from laboratory to laboratory.
https://labtestsonline.org/tests/levetiracetam
Doses of all anti epileptics are weight based, for levetiracetam dose around 15-30 mg/kg.
2nd most important thing is type of seizure , focal or generalised ?
as standard practice before adding another drug one should reach to maximum dose or pt developed some adverse reaction.
It is always advisable that one should take medicine under direct supervision of neurologist.
Noted. What is the gender of this patient? If she is female, and you mention that the minor seizures occur "once in a month" please consider Catamanial seizures and mange appropriately. One would usually give an add-on drug such as Clobazam at a low dose e.g 5 mg nocte. This add-on can be given cyclically say one or two days before the beginning of menses if the cycle is very regular (or at the onset of pre-menstural signs), and continued throughout the menstural days up to two days after the last day of menstural flow. This cycle is repeated monthly. However, if the patient is male, you could give the same Clobazam as add-on at a low dose of 5 mg note continuously with Levetiracetam. It is also important to do Therapeutic Drug Monitoring. I hope this helps
@ James Jowi, @Anand Kumar, @ Donna Lissi,@ Mauro Luisetto - Thanks, a lot for your valuable advice. The pains taken are gratefully acknowledged and the suggestions made are carefully noted. Thanks again.
Keppra is one of the safest AED available. you can increase the dose and monitor response . Very rarely will e toxic in a young patient. Behavioral/ mood issues are the most common side effect.
also can be used to treat partial and generalized epilepsy.
You can try to increase to 750 mg BID and monitor response.
@ Thanks a lot Mariana. Your suggestion appears to be valuable. I have increased it to 750 in the morning and 500 in the night. I hope this works or I will switch to 750 BID
From Paul, is it possible to know what mild seizures represent ( non- epileptic seizures or spasms). Is it change of seizure type from generalized to partial form which I would consider an improvement. If non-epileptic seizures, then there is need to review treatment taking into consideration the underlying psychological status. In that case carbamazepine would provide a better alternative
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