International Journal of Clinical Pharmacy

, Volume 37, Issue 4, pp 559–562 | Cite as

Role of high-dose levetiracetam as add-on therapy for intractable epilepsy: case report and brief review of the literature

  • Hector Mateo-CarrascoEmail author
  • Pedro Jesús Serrano-Castro
  • Emilio Molina-Cuadrado
  • Mel Goodwin
  • Timothy V. Nguyen
  • Primal N. Kotecha
Case Report


Case We discuss the case of a 5-year-old long-standing epileptic woman, who received oxcarbazepine 2.1 g/day, and levetiracetam 3 g/day (started in 2005 and up-titrated according to response). In October/2008, due to poor seizure control, patient consent was obtained and levetiracetam up-titrated to 6 g/day, remaining invariable for 72 months; zonisamide was added in July/2009 and up-titrated to 500 mg/day. This combination achieved seizure frequency reduction ≥50 %, however, the patient ultimately necessitated temporal lobectomy for complete remission. Occasional agitation and moderate depression were the main side effects. Conclusion Three anti-epileptic drugs (including levetiracetam 6 g/day) achieved statistically-significant seizure frequency reduction ≥50 % compared with lower doses, but not seizure freedom. Low-dose risperidone was initiated due to transient dose-dependent agitation, although it did not lead to discontinuation. This report provides insightful information on the use of high-dose levetiracetam in focal refractory epilepsy. The concomitance of anti-epileptics may have contributed to both efficacy and toxicity. Therefore, the risk/benefit ratio must be individually weighed until larger studies are available.


Case reports Epilepsy Keppra® Levetiracetam Maximum tolerated dose 




Conflicts of interest



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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Hector Mateo-Carrasco
    • 1
    Email author
  • Pedro Jesús Serrano-Castro
    • 2
  • Emilio Molina-Cuadrado
    • 3
  • Mel Goodwin
    • 4
  • Timothy V. Nguyen
    • 5
    • 6
  • Primal N. Kotecha
    • 7
  1. 1.Pharmacy DepartmentNorthampton General Hospital NHS TrustNorthamptonUK
  2. 2.Neurology and Neurophysiology UnitTorrecardenas HospitalAlmeríaSpain
  3. 3.Pharmacy DepartmentTorrecardenas HospitalAlmeríaSpain
  4. 4.Neurology DepartmentNorthampton General HospitalNorthamptonUK
  5. 5.Pharmacy Faculty Council, AMS College of Pharmacy and Health SciencesLong Island UniversityBrooklynUSA
  6. 6.LIU’s Division of Physician Assistant StudiesSaint Peter’s UniversityJersey CityUSA
  7. 7.Pharmacy DepartmentKettering General Hospital NHS TrustKetteringUK

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