- |||||||||| lacosamide / Generic mfg., levetiracetam / Generic mfg., oxcarbazepine / Generic mfg.
Seizures in the Leukodystrophies (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3442;
Abnormal MRI brain and generalized slowing on EEG are widespread in this cohort and do not confer increased seizure risk. Patients with generalized discharges have higher risk of seizures compared with focal discharges.
- |||||||||| levetiracetam / Generic mfg., ibuprofen / Generic mfg.
Adolescent with Unusual Initial Presentation of MOGAD (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3341;
Given the clinical phenotype, and a positive MOG antibody test, it fits the international MOGAD Panel proposed criteria. Children aged ten and over have a higher risk of relapse.
- |||||||||| Xcopri (cenobamate) / SK Bio, Angelini Group, Endo
Leukemoid Reaction in the Setting of Status Epilepticus: A Case Report (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3257;
The patient was treated with midazolam by EMS and loaded with levetiracetam on arrival to the hospital...Presenting lacosamide and cenobamate levels were subtherapeutic...Status epilepticus is an emergent condition that yields considerable physiologic stress as evidenced by this patient's severe lactic acidosis and CPK elevations. It should be recognized as an etiology for leukemoid reaction due to inflammatory leukocyte margination.
- |||||||||| prednisone / Generic mfg., levetiracetam / Generic mfg.
COVID-19-related Acute Hemorrhagic Leukoencephalitis: A Great Outcome for a Grim Diagnosis (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3078;
Seizures were controlled with levetiracetam. This unique case of AHL presumed secondary to COVID-19 infection (independently diagnosed at two different centers) showed excellent recovery due to early treatment with IVIG and steroids, which likely played a pivotal role in preventing a grave outcome.
- |||||||||| levetiracetam / Generic mfg.
Autonomic Seizure as a Presenting Symptom of Glioblastoma (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3048;
The rarity of pilomotor seizures as a sole presenting feature complicates diagnosis, emphasizing the need for a comprehensive approach to unconventional seizures. Through rigorous assessment, continuous EEG monitoring, and imaging, we identified a non-enhancing left temporal lobe mass, confirmed as glioblastoma.
- |||||||||| Fycompa (perampanel) / Eisai, Catalyst Pharma
Stridor of Epileptic Origin (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3047;
Lacosamide, Perampanel and Phenytoin were added sequentially...Stridor due to paradoxical vocal cord movement is a possible semiology of seizures originating from fronto-central lesions. Clinicians should be vigilant to such rare forms of semiology in the proper clinical settings.
- |||||||||| levetiracetam / Generic mfg.
Recurrent Syncope: Ictal Asystole Associated with Glioblastoma (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3045;
Capturing syncopal events on cardiac telemetry and cEEG is essential for diagnosis, especially for patients with multifocal ictuses for seizures. Neurologists and cardiologists should be aware of this phenomenon as timely and accurate diagnosis is critical for optimal management.
- |||||||||| levetiracetam / Generic mfg., carbamazepine / Generic mfg.
A Case of a Rare Seizure Mimic: Acute Intermittent Porphyria Attack (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_3044;
The diagnosis of porphyria was complex due to the patient's inability to verbalize his symptoms, difficulty differentiating seizure from porphyria attacks, and complex video EEG and laboratory evaluation. This case illustrates a rare seizure mimic, important clinical consideration, and testing in improving patient outcome and reducing morbidity.
- |||||||||| levetiracetam / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Hu Would Have Thought, Eh? An Interesting Case of Temporal Lobe Epilepsy in an Elderly Patient (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2613;
It also shows an unexpectedly good clinical and electrographic response to immunosuppression. Finally, we appreciated how the EEG was used as an objective marker of improvement in a patient recovering from limbic encephalitis.
- |||||||||| verapamil / Generic mfg., aspirin / Generic mfg., levetiracetam / Generic mfg.
Reversible Cerebral Vasoconstriction Syndrome Presenting as Micturition Headaches in a Pediatric Patient (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2574;
Finally, we appreciated how the EEG was used as an objective marker of improvement in a patient recovering from limbic encephalitis. Diagnosis of RCVS was suspected based upon imaging and history, so he was started on verapamil and aspirin...These episodes resolved with levetiracetam...This case highlights the importance of careful clinical history and neuroimaging in pediatric patients presenting with thunderclap headaches.
- |||||||||| lamotrigine liquid oral suspension / OWP Pharma
That Tickles!: A New Type of Reflex Epilepsy (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2502;
The pathophysiology of "tickling" epilepsy is unknown. Behavior modification may be a necessary intervention to avoid seizures.
- |||||||||| Rituxan (rituximab) / Roche
Case Report: Cerebral Syphilitic Gumma in a Patient with Relapsing-remitting Multiple Sclerosis on Rituximab (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2479;
The immunosuppressive effects of anti-CD20 therapy in patients with MS and related conditions increases the risk for atypical infections, such as cerebral syphilitic gumma. Our case also highlights the importance of addressing social determinates of health in management of patients with chronic medical conditions and the need for recurrent infectious screening in high-risk populations.
- |||||||||| mycophenolate mofetil / Generic mfg.
Brain Lesions in a Myasthenia Gravis Patient on Monotherapy with Mycophenolate Mofetil (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2246;
Levetiracetam every twelve hours was started without further seizures...Patient subsequently underwent treatment with intravenous sulfamethoxazole and trimethoprim combination for six weeks...This is a rare case of neurotoxoplasmosis as a complication of monotherapy with mycophenolate mofetil and highlights the importance of having a high index of suspicion for opportunistic neuroinfectious processes. Especially in those patients with immunosuppressive therapy presenting with new neurological deficits or radiological findings.
- |||||||||| Noxafil (posaconazole) / Merck (MSD), Cresemba (isavuconazonium sulfate) / Astellas, Basilea
Management and Outcome in a Case of Cerebral Phaeohyphomycosis Due to Rhinocladiella Mackenziei in an Immunocompetent Individual (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2242;
Initial management involved empirical therapy for brain abscess including antibiotics (ceftriaxone, vancomycin, metronidazole) and dexamethasone, along with antiseizure medication (levetiracetam)...The treatment protocol was then adjusted based on fungal culture results to targeted therapy with intravenous liposomal amphotericin B. Subsequent MRI showed recurrence of the right parietal lesion and the emergence of a smaller lesion...This case highlights the potential for successful management of cerebral phaeohyphomycosis with a combination of surgical and medical therapies, including the use of triazole-class antifungal drugs like posaconazole and isavuconazole. Given its rarity, with only 42 cases reported globally, further research is needed to inform strategies for managing this severe infection.
- |||||||||| levetiracetam / Generic mfg., clobazam / Generic mfg.
Novel Variant in ARHGEF15 is Associated with Epilepsy with Myoclonic-atonic Seizures in a Pediatric Patient (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2204;
The ARHGEF15 gene, on chromosome 17 encodes the Rho guanine nucleotide exchange factor 15 (GEF), which regulates activity of RhoA and downstream effector molecules. In vitro knockout studies on this gene showed an overexpression of excitatory synapses which may help explain its role in epileptogenesis.
- |||||||||| donepezil / Generic mfg., levetiracetam / Generic mfg., sumatriptan succinate / Generic mfg.
Pilot Study: Implementation of a Neurology-free Clinic in Columbus, Ohio (Colorado Convention Center | Exhibit Hall B-E) - Mar 8, 2024 - Abstract #AAN2024AAN_2016;
The implementation of neurological clinical care to uninsured/underinsured patients can be achieved through collaborative work between students, residents, and ancillary services. This model of care can be replicated by other specialties and institutions to provide free care for patients in need of such services.
- |||||||||| Journal: Lettre to editor: Case report of an ictal asystole as debut in new onset epilepsy. (Pubmed Central) - Mar 6, 2024
Anti-seizures drugs must be initiated in all patients, and there is a recommendation to avoid those with negative inotropic and arrhythmogenic effects (such as phenytoin, carbamazepine, and lacosamide). There is a discussion about pacemaker indication, however, it is highly recommended in non-controlled epilepsy and in ictal asystoles that last for more than 6
- |||||||||| levetiracetam / Generic mfg.
Trial initiation date: LeviTaTe Pilot: Levetiracetam Prophylaxis in Brain Tumor Resection Pilot (clinicaltrials.gov) - Mar 2, 2024
P3, N=70, Not yet recruiting,
Together, these data address several long-standing gaps in our understanding of the neurotoxic profile of antiseizure medications during early postnatal development. Initiation date: Dec 2023 --> Jun 2024
- |||||||||| Reimbursement, US reimbursement, Journal, Claims database: Comparing the efficacy of anti-seizure medications using matched cohorts on a large insurance claims database. (Pubmed Central) - Feb 28, 2024
However, we note that our data set for this study only used insurance claims events, which does not comprise actual seizure frequencies, nor a clear picture of side effects. Our results do not advocate for any change in practice but demonstrate that conclusions from large databases may differ from and supplement those of randomized trials and clinical practice and therefore may guide further investigation.
- |||||||||| Fycompa (perampanel) / Eisai, Catalyst Pharma
Review, Journal, Metastases: Antiepileptic Strategies for Patients with Primary and Metastatic Brain Tumors. (Pubmed Central) - Feb 27, 2024
The consensus among most Neuro-Oncology providers is to initiate levetiracetam monotherapy after a first seizure in a brain tumor patient, as long as the patient does not have any psychiatric co-morbidities. If levetiracetam is not tolerated well or is ineffective, other appropriate initial AED options for monotherapy or as an add-on anticonvulsant include lacosamide, valproic acid, briviracetam, lamotrigine, and perampanel.
- |||||||||| levetiracetam / Generic mfg.
Journal: Therapeutic drug monitoring in pregnancy: Levetiracetam. (Pubmed Central) - Feb 24, 2024
LEV serum level monitoring is essential for WWE prior to and during pregnancy as well as postpartum. Our data contribute to determining a rational treatment and dosing paradigm for LEV use during both pregnancy and the postpartum period.
- |||||||||| Multifactorial Encephalopathy: A Rare Case of Primary Central Nervous System (CNS) Lymphoma With Hypothalamic and Pituitary Involvement (San Diego Convention Center, Room 1A-B (Upper Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_7692;
She was started on levetiracetam and dexamethasone for cerebral edema which was recognized to be the main cause of her encephalopathy...She was started on intravenous high-dose methotrexate treatment and discharged to continue with chemotherapy and desmopressin with endocrinology and oncology follow-up...Our patient demonstrated panhypopituitarism with significant improvement in symptoms with appropriate hormone replacement. While our patient's encephalopathy was multifactorial in etiology, our case highlights the importance of a complete endocrinologic assessment and keeping broad differential diagnoses when encountering patients with hyponatremia and encephalopathy.
- |||||||||| levetiracetam / Generic mfg., furosemide / Generic mfg.
A Cautionary Tale: A Case of Acute Inhalation Pneumonitis Due to Household Cleaning Supplies (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_6345;
Treatment for inhalation pneumonitis includes supportive care with supplemental oxygen. In unstable patients early intubation is recommended while the role of steroids is controversial but can aid if hypoxia persists with no clinical improvement.
- |||||||||| levetiracetam / Generic mfg.
Levetiracetam-associated Rhabdomyolysis (San Diego Convention Center, Area K (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_6040;
He received multiple doses of lorazepam and required intubation for airway protection...Levetiracetam was discontinued and changed to lacosamide...The adverse event of rhabdomyolysis following levetiracetam administration remains rare. When evaluating a patient with rhabdomyolysis special attention needs to be paid to history and physical examination as well as medications administered.
- |||||||||| brivaracetam / Generic mfg.
Brivaracetam-Related Neurological Decline in a Patient With Complex Medical History (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5977;
Introduction: Brivaracetam is a newer anticonvulsant that is a propyl analogue of levetiracetam...Of note, during a recent hospitalization, the patient was started on Cefepime for treatment of UTI and developed seizures afterwards, she was later discharged on Brivaracetam...Ammonia levels improved with holding tube feeds and treatment with lactulose and Rifaximin; however, there was no improvement in mental status...In our case ammonia levels were elevated as well suggesting a possible association. Further research is needed to better understand the relationship between Brivaracetam and neurological decline in patients with complex medical backgrounds, shedding light on the importance of careful medication reconciliation and close monitoring in such cases.
- |||||||||| fentanyl citrate / Generic mfg., levetiracetam / Generic mfg.
CHANTER Syndrome: A Rare Neurological Toxidrome (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5945;
DESCRIPTIONA 47-year-old lady with seizure disorder, HIV, SLE, depression, suicide attempts, polysubstance use (PCP, meth, cocaine) and metabolic syndrome was evaluated in the ICU after being found unresponsive 3 days after she had used fentanyl...She was treated with aspirin, atorvastatin, Keppra and hypertonic saline...The grey matter of the hippocampus and basal nuclei is often involved. With early aggressive treatment, outcomes are more favorable compared to hypoxic ischemic encephalopathy.
- |||||||||| A Rare Case of Idiopathic Intracranial Hypertension in a 21-year-old Male Patient Presenting With Seizures (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5944;
Gradual weaning of IV sedation occurred, and scheduled diazepam was introduced and subsequently tapered...Moreover, the management of IIH involves the use of carbonic anhydrase inhibitors such as acetazolamide, as well as medications with carbonic anhydrase inhibitor activity like topiramate. Ventriculoperitoneal shunts are reserved in cases of rapid vision loss.
- |||||||||| levetiracetam / Generic mfg., prazosin / Generic mfg.
Overcoming Drowning, Cardiopulmonary Arrest and Severe ARDS With ECMO for a Positive Neurological Outcome (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5900;
Patient was noted to have myoclonic jerks and started on Keppra for seizure prophylaxis...Patient had an additional hospital stay of one week while completing antibiotics and being managed for acute stress disorder with prazosin 1 mg nightly and neurocognitive rehabilitation...Complete neurological recovery post CPR and ECMO have not been studied well. Further studies are hence necessary to establish evidence-based protocol to guide clinical management and initiate early ECMO.
- |||||||||| levetiracetam / Generic mfg.
A Case of Keppra-Induced Torsades de Pointes in a Patient With Congenital Long QT Syndrome (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_3585;
Clinicians should be aware that malignant arrhythmias such as TdP can lead to arrhythmic syncope with generalized seizure activity. If this seizure activity is misdiagnosed as a primary seizure disorder in a patient with LQTS, clinicians should be aware that Keppra does have an increased risk of QT prolongation in the LQTS population and initiation could have fatal outcomes.
- |||||||||| New-onset Refractory Status Epilepticus Induced by Synthetic Marijuana: A Case Report (San Diego Convention Center, Area A (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1690;
The patient's initial seizure episode was broken with 2 mg of Midazolam enroute to the emergency room...To control ongoing seizures, increase of levetiracetam, started fosphenytoin and phenobarbital, and provided as needed lorazepam...It highlights the need for heightened vigilance and a broader differential diagnosis in patients presenting with refractory seizures. Future research should investigate the incidence of NORSE associated with synthetic marijuana, potentially decreasing the number of NORSE determined as cryptogenic.
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