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Challenge to levetiracetam’s de facto position as generic first-line antiseizure medication
  1. Aidan Neligan1,2,
  2. Matthew Walker2,3,
  3. Sanjeev Rajakulendran2,3
  1. 1 Neurology, Homerton University Hospital, London, UK
  2. 2 DCEE, UCL Queen Square Institute of Neurology, London, UK
  3. 3 National Hospital for Neurology and Neurosurgery Queen Square, London, UK
  1. Correspondence to Dr Aidan Neligan, Neurology, Homerton University Hospital, London, UK; a.neligan{at}

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Since its inauspicious beginnings as an unsuccessful cognitive-enhancing drug and disappointing impact on animal seizure models in the 1990s, levetiracetam has gone from strength to strength, becoming an antiseizure ‘blockbuster’ with yearly sales of over 1 billion dollars in the USA.1 Following its licensing for focal-onset seizures in 1999 in the USA and 2000 in Europe, the use of levetiracetam has escalated2 3 to the point that it is now among the most commonly prescribed antiseizure medications in resource-rich countries. Indeed, it is best known by its brand name, resulting in large numbers of prescriptions for branded Keppra rather than the much cheaper levetiracetam.

A convergence of factors has catapulted levetiracetam to the top of the antiseizure medication armamentarium, including a simple dosing regimen, lack of clinically meaningful drug interactions and skilful marketing. Its increasing familiarity among medical specialities has led to its creeping use in a range of scenarios, often inappropriately, including the acute management of first seizures (particularly when more than one episode has occurred), suspected seizures in older people having excluded a vascular cause for a stroke-like presentation, and as prophylaxis for elective neurosurgery. Indeed, the …

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  • Contributors All three authors were involved in the concept, drafting and final approval of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AN has received a speaking honoria from UCB Pharma and a consultancy fee from SAGE Pharmaceuticals Ltd. MW reports grants from Vitaflo, personal fees from UCB Pharma, personal fees from Eisai, personal fees from GSK, personal fees from Pfizer, personal fees from Special Products, personal fees from Sage pharmaceuticals, personal fees from GW Pharmaceuticals, personal fees from Marinus Pharmaceuticals, outside the submitted work. In addition, Dr Walker has a patent composition for the use in the treatment of epilepsy. WO2018189113A1 licensed, a patent combination comprising decanoic acid for the treatment of epilepsy. WO2019002435A1 pending, a patent therapeutic use of compounds. EP2642990B1 issued, a patent combined use of a vector encoding a modified receptor and its exogenous agonist in the treatment of seizures. US10525103B2 issued, and a patent expression vectors comprising engineered genes. WO2018229254A1 pending. SR has no competing interests.

  • Provenance and peer review Commissioned, externally peer reviewed by Tony Marson, Liverpool, UK.

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    Phil E M Smith Geraint N Fuller

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