An investigation of the ocular toxic effects of levetiracetam therapy in children with epilepsy
To investigate the potential toxic effects of levetiracetam monotherapy on ocular tissues in cases of pediatric epilepsy using optical coherence tomography (OCT).
Thirty epileptic children (group 1) receiving levetiracetam monotherapy at a dosage of 20–40 mg/kg/day for at least 1 year with a first diagnosis of epilepsy and 30 age- and gender-matched healthy children (group 2) were included in the study. In addition to a detailed eye examination, peripapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, foveal thickness (FT), and central corneal thickness (CCT) were measured in all children by means of spectral domain OCT. The data obtained from the two groups were then subjected to statistical analysis.
The mean age of both groups was 12 ± 3.64 years [1–12]. The mean duration of levetiracetam in group 1 was 24.07 ± 12.82 months. Mean RNFL values in groups 1 and 2 were 106.1 ± 10.42 and 104.98 ± 10.04 μm, mean GCC values were 94.72 ± 6.26 and 94.4 ± 6 μm, mean FT values were 240.73 ± 17.94 and 240.77 ± 15.97 μm, and mean CCT values were 555.1 ± 44.88 and 540.97 ± 32.65 μm, respectively. No significant difference was determined between the two groups in terms of any parameter. Best corrected visual acuity values of the subjects in both groups were 10/10, and no color vision or visual field deficit was determined.
Levetiracetam monotherapy causes no significant function or morphological change in ocular tissues in pediatric epilepsies.
KeywordsEpilepsy Optical coherence Levetiracetam Tomography
Compliance with ethical standards
Ethical approval was granted for the study. Informed consent was received from all children and their parents.
Conflict of interest
The authors have no proprietary or financial interest in this study.
- 6.Fountain NB, Conry JA, Rodríguez-Leyva I, Gutierrez-Moctezuma J, Salas E, Coupez R, Stockis A, Lu ZS. Prospective assessment of levetiracetam pharmacokinetics during dose escalation in 4- to 12-yearold children with partial-onset seizures on concomitant carbamazepine or valproate. Epilepsy Res 2007;74(1):60–69. Epub 2007 Jan 31Google Scholar
- 8.Lyseng-Williamson KA (2011) Levetiracetam: a review of its use inepilepsy. Drugs 71(4):489–514Google Scholar
- 9.Lee T, Warrick BJ, Sarangarm P, Alunday RL, Bussmann S, Smolinske SC, Seifert SA (2017) Levetiracetam in toxic seizures. Clin Toxicol (Phila):1–7. https://doi.org/10.1080/15563650.2017.1355056
- 13.Ngugi AK, Kariuki SM, Bottomley C, Kleinschmidt I, Sander JW,Newton2011 CR. Incidence of epilepsy: a systematic review and meta-analysis. Neurology ;77(10):1005–1012Google Scholar
- 19.Zhang X, Iverson SM, Tan O, Huang D. Effect of signal intensity on measurement of ganglion cell complex and retinal nerve fiber layer scans in Fourier-domain optical coherence tomography. Transl Vis SciTechnol 2015; 4(5): 7. Published online 2015 Oct 1Google Scholar
- 20.Ho J, Sull AC, Vuong LN, Chen Y, Liu J, Fujimoto JG, SchumanJS, Duker JS. Assessment of artifacts and reproducibility across spectraland time-domain optical coherence tomography devices. Ophthalmology 2009;116(10):1960–1970Google Scholar
- 21.Kanski JJ. Clinical ophthalmology: a systematic approach (4th ed.) Butterworth-Heinemann, Ajanta Offset, New Delhi, 2000, p.96–98Google Scholar
- 22.Whitcher JP, Srinivasan M, Upadhyay MP (2001) Corneal blindness: aglobal perspective. Bull World Health Organ 79(3):214–221 Epub 2003 Jul 7Google Scholar
- 24.Ceylan OM, Turk A, Erdurman C, Mumcuoglu T, Erdem U, GokceG, Dagli S. Comparison of oculus pentacam and stratus optical coherence tomography for measurement of central corneal thickness. Cornea 2011;30(6):670–674Google Scholar
- 35.Mosinger Ogilvie J, Deckwerth TL, Knudson CM, Korsmeyer SJ (1998) Suppression of developmental retinal cell death but not of photoreceptor degeneration in Bax-deficient mice. Invest Ophthalmol Vis Sci 39(9):1713–1720Google Scholar
- 36.Chen J, Flannery JG, LaVail MM, Steinberg RH, Xu J, Simon MI. Bcl-2 overexpression reduces apoptotic photoreceptor cell death in three different retinal degenerations. Proc Natl Acad Sci U S A 1996 Ju 9;93(14):7042–7047Google Scholar
- 37.Elmore S (2007) Apoptosis: a review of programmed cell death. ToxicolPathol 35(4):495–516Google Scholar