The Clinical Analysis Of Vitamin B6as Adjuvant Of Levetiracetam Treatment Of Pediatric Epilepsy

Background：Epilepsy is a common chronic neurological disorders of children．The treatment of epilepsy in children and adolescents is clinically challenging，due tothe special period of growth，worse performance on many neurocognitive andbehavioral variables in comparison with children without epilepsy，or significant sideeffects with antiepileptic drug therapy．Afurther consideration is the potential negativeimpact of antiepileptic drug therapy on brain development and neuropsychologicalfunction．Levetiracetam (LEV) is a highly effective antiepileptic agent．Behavioral sideeffects related to the use of levetiracetam in epilepsy are increasingly beingrecognized，and can lead to LEV discontinuation．The key role of vitamin B6in thehuman developing is in metabolism，especially of the neurotransmitters．Objective： The aim of this study was to assess the effect of vitamin B6supplementation to improve the LEV-induced behavioral side effects．Method：To retrospectively analysis sixty-two cases of children with epilepsyreceiving LEV monotherapy treatment from the Epilepsy center of the Second AffiliateHospital of Dalian Medical University between Mar.2008and Aug.2013． Weidentified group A and B according to whether adding vitamin B6， and then dividedgroup A to three pieces according to the timing of vitamin B6initiation in relation toLEV．Both vitamin B6and LEV were initiated at the same time as group A1，usedpyridoxine intermittently as group A2， started vitamin B6because of significantbehavioral side effects after being on LEV as group A3．According to the parentsdescribing adverse events， abnormal behaviors of children were detailed records(excitement，aggression，irritability，drowsiness)．The following variables were assessed：behavior difficulties prior and during treatment with LEV，timing of vitaminB6supplementation in relation to LEV initiation，effect of vitamin B6supplementationon behavior，side effects related to vitamin B6．And we retrospectively reviewed thesepatients charts to collect additional information about patients age，gender，weight，etiologies of epilepsy，seizure types，imaging and EEG results.Result：The A1group consisted of11patients，only one case(9%) had theLEV-induced irritability．The A2group comprised14patients who did not experienceside effects related to LEV．In the A3group，22patients started vitamin B6because ofsignificant behavioral side effects after being on LEV． Significant behavioralimprovement was observed in three patients (60%)，no effect in two (40%)．In the Bgroup，32patients had LEV monotherapy，5cases(15.625%) developed behavioral sideeffects (drowsiness in2，irritability in1，aggression in1，1Landau-Kleffner Syndromepatient had the exciting symptom worsen after using LEV)．The behavioral side effectsoccur in group A1+2and B showed no statistically significant difference(X2=0.96，P>0.05)．The LEV-induced side effects occurred in drug increase period. No adverseeffects associated with vitamin B6was found in this study．Conclusion：1.The LEV-induced side effects occurred in drug increase period.2.Low dose of VitaminB6supplementation in the treatment ofLEV-induced behavioral side effects did not show exact role．...