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Pyridoxine supplementation for the treatment of levetiracetam-induced behavior side effects in children: Preliminary results

      Abstract

      Behavioral side effects related to the use of levetiracetam (LEV) in epilepsy are increasingly being recognized. Patients followed in our center have reported improvement of these side effects after starting pyridoxine (vitamin B6) supplements. Using mailed questionnaires, retrospective chart reviews, and phone call follow-ups, we analyzed 42 pediatric patients who had been treated with LEV and pyridoxine. Twenty-two patients started pyridoxine after being on LEV, and significant behavioral improvement was observed in nine (41%), no effect in eight (36%), deterioration in four (18%), and an uncertain effect in one. The effects of pyridoxine supplementation were observed during the first week. The remaining patients (20) were already on pyridoxine before LEV was started, started pyridoxine and LEV at the same time, or took pyridoxine intermittently. Pyridoxine is an easily available, inexpensive, and safe therapeutic option. Given these preliminary results, we plan to conduct a placebo-controlled cross-over study to better characterize these observations.

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      References

        • Sirsi D.
        • Safdieh J.E.
        The safety of levetiracetam.
        Expert Opin Drug Saf. 2007; 6: 241-250
        • Harden C.
        Safety profile of levetiracetam.
        Epilepsia. 2001; 42: 36-39
        • White J.R.
        • Walczak T.S.
        • Leppik I.E.
        • et al.
        Discontinuation of levetiracetam because of behavioral side effects: a case–control study.
        Neurology. 2003; 61: 1218-1221
        • Miller G.S.
        Pyridoxine ameliorates adverse behavioral effects of levetiracetam in children.
        Epilepsia. 2002; 43: 62
        • Huerter V.
        • Thiele E.A.
        The role of levetiracetam in pediatric epilepsy and tuberous sclerosis complex.
        Epilepsia. 2003; 44: 134
        • Chez M.G.
        • Murescan M.
        • Kerschner S.
        Retrospective review of the effect of vitamin B6 (pyridoxine) as add-on therapy for behavioral problems associated with levetiracetam (Keppra) therapy.
        Epilepsia. 2005; 46: 146
        • Clayton P.T.
        B6 -responsive disorders: a model of vitamin dependency.
        J Inherit Metab Dis. 2006; 29: 317-326
        • Coleman M.
        • Steinberg G.
        • Tippett J.
        • et al.
        A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double-blind crossover comparison with methylphenidate.
        Biol Psychiatry. 1979; 14: 741-751
        • Wyatt K.M.
        • Dimmock P.W.
        • Jones P.W.
        • Shaughn O’Brien P.M.
        Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review.
        Br Med J. 1999; 318: 1375-1381
        • Bender D.A.
        Non-nutritional uses of vitamin B6.
        Br J Nutr. 1999; 81: 7-20
        • Coursin D.B.
        Convulsive seizures in infants in pyridoxine deficient diets.
        JAMA. 1954; 154: 406-408
        • Rogawski M.A.
        Diverse mechanisms of antiepileptic drugs in the development pipeline.
        Epilepsy Res. 2006; 69: 273-294