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Neuroscience

Research Snapshot Theater: Neuroscience/Pharmacology, Adult II

(772) Levetiracetam-Induced Rhabdomyolysis: A Systematic Review of the Literature

Sunday, February 23, 2025
11:00am – 12:00pm Eastern Time
Location: Connections Central - RST 01

    First Author(s)

  • CB

    Clotilde Balucani, N/A

    Northwell Health - Lenox Hill Hospital
    Department of Neurosurgery, Lenox Hill Hospital  Donald and Barbara Zucker School of Medicine at Hofstra/Northwell 
    Brooklyn, New York, USA

    • Co-Author(s)

  • CM

    Carlton Menchaca, N/A

    PharmD
    Bellevue Hospital NYC-HHC, New York, United States

Introduction: Since its introduction, levetiracetam (LEV) has become one of the mainstay anti-seizure medications (ASM), well tolerated, with few adverse effects. Rhabdomyolysis as defined by a significant increase in serum creatine phosphokinase (CPK) levels has been reported following LEV initiation. The purpose of this study was to evaluate the association between LEV and rhabdomyolysis, and to characterize associated risk factors and outcomes.

Methods: A systematic review of the literature was conducted following the PRISMA guidelines. PubMed and Google Scholar were interrogated with predefined search terms. Two reviewers independently identified potentially eligible articles. Of the total articles initially retrieved, those relevant were read in full and appraised for eligibility to enter the final analysis.

Results: Twenty-nine articles published between 2012 and 2024 entered the final review; 28 single case reports, one case series; two additional cases included from our center. The final analysis included 34 patients, of these: 24/34 (70.6%) men and 10/34 (29.4%) women (95% Confidence Intervals: 1.11-5.62); mean age 33.8 years (Standard Deviation: 15.9); in 21/34 (61.8%) CPK raised within 24 hours after LEV initiation and in 30/34 (88.2%) normalized after LEV discontinuation. An average of 8.5 (1-29) CPK essays were reported. The average peak of CPK was 48,819 IU/L (986-92,167); 12/29 (41.4%) received other ASMs; In 6/34 (17.6%) there was a concomitant kidney disfunction and in 1/34 (2.9%) multi-organ failure.

Conclusions: LEV-induced rhabdomyolysis has been more frequently reported over the past decade. It affects men more than women. CPK elevation occurs early after LEV initiation and normalizes after discontinuation. It can be associated with kidney dysfunction, potentially affecting clinical outcomes. Rhabdomyolysis should be considered when initiating LEV. Mechanisms underlying this adverse effect deserve further investigations.