TY - JOUR T1 - Challenge to levetiracetam’s de facto position as generic first-line antiseizure medication JF - Practical Neurology JO - Pract Neurol SP - 94 LP - 95 DO - 10.1136/practneurol-2021-003217 VL - 22 IS - 2 AU - Aidan Neligan AU - Matthew Walker AU - Sanjeev Rajakulendran Y1 - 2022/04/01 UR - http://pn.bmj.com/content/22/2/94.abstract N2 - 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 … ER -