Levetiracetam for neuropathic pain

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A DGReview of : " Levetiracetam in the treatment of neuropathic pain:

three case studies " Clinical Journal of Pain Clin J Pain. 2004;20:33-36.

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, 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 nd 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.