Levetiracetam

Yeah, it's going to be a great night.

I will not take my Keppra as well.

We'll be on.

I usually don't take it till 1030 anyway.

And so he's now our new neurologist.

And so we call them and they get us a room and everything's now back on his head they're still happening again is this still 2020 this is still 2020 it's now just before new year's eve so we're like staying there we're this is now you know and he says he's gonna call the genetics place because it's usually a six-week wait but jesus wrote wrote a book on childhood epilepsy i know he has connections like there's no way because he makes some phone calls to try and expedite these results because his thing is, we have a baby that won't stop seizing, medicine is not working, and he does not like he is having us come down on this Keppra because he's like, you cannot give a brain of a four-month-old baby a seven-year-old dose.

Like this is insane.

Like that is, I mean, this is just America.

So then they said, okay, try another anticonvulsant medication.

And I was on ones like, if anyone watching the show knows about like epilepsy and anticonvulsants, like, Kepra, I took one called Kepra and then I took another one called the Lamictal and Zebenix.

And he said, okay, cause Kepra didn't work, then we'll put you on Zebenix.

Like, cause you're still getting the petty mal seizures or smaller seizures, we'll put you on Zebenix and Lamictal and Lamotrigine, that's another word for Lamictal.

And neither of those, and even then, it didn't, even those still wasn't fully healing to me.

But then one of the solutions was, instead of seeking anything else out, they wanted to prescribe her a certain medication.

I believe it was Keppra was the name of it.

And it has some pretty severe side effects, especially.

for a five-year-old suicidal thoughts and aggression and all those things.

Okay, you're not going to tell me that that's just coincidental.

Hundreds of years ago, that's all they had.

There was no such thing as Keppra.

But I wasn't taught that in school.

He has late in life epilepsy.

So every night at 930, he has to receive three Keppra pills and Cha-Cha gets a placebo because I don't want her to feel left out.

And so Tubby's pills are wrapped in roast beef.

Cha-Cha gets just the roast beef.

I can report both the Keppra and the placebo result in no seizures.

So do with that what you will.

But nonetheless, at 9.30 on the dot, because you have to be very rigorous about the time in which you dispense the Keppra, which is the anti-seizure medication.

Immediately afterwards, they go outside.

So we're going to give benzodiazepines at the first five minutes and then move promptly to an appropriate second line drug and escalate refractory seizures with continuous EEG monitoring and anti-epileptics.

What we notice from trials is that there is similar success with levotiracetam, commonly known as Keppra, phosphonitoin, and valproate.

Approximately half of patients are going to respond.

So contraindications in clinical context is going to really help guide the selection.

So I guess it's just to try protect them for when they're needed most.

Like, if you take antibiotics such as your cephalosporins, which is the drug used in Keppra and dry cow tubes, they're also being used in many hospital operations, I suppose, to stop infections, that same drug.

So we, we just need to be careful not to make the bugs resistant to them drugs through misuse, really.

And, like, it's not just farmers I'm talking about either.

After the first week, those appointments do shift to twice weekly, and then we do weekly after that until about a month out.

The levetiracetam and Keppra prophylaxis I find fascinating, so I, I like hearing Erin's perspective on that.

We start a little earlier with LB chemo, my theory always being that if a patient did have toxicity, I wanted to be able to identify it beforehand.

And I, I do think that that toxicity monitoring, I was taught in pharmacy school about Keppra rage, and we've had a couple patients.

The one that comes to mind is his wife asked if CAR T could change your personality and we, we said, "We're not really sure.

I wouldn't think so." But whenever we stopped the Keppra, he, he went a lot back more to being his normal self.

And so it's always challenging to evaluate what actually is causing toxicity, but my radar recently has been more tuned to could Keppra be causing toxicity, and can we pull this off sooner in patients? Even though similar to Erin, we do use it across the board for all patients for at least thirty days, and then we'll extend it for another month if patients do have significant ICANS.

ICANS.So interesting, the scope, I guess just starting with lab monitoring.