Effect of levetiracetam drug on antioxidant and liver enzymes in epileptic patients: case-control study

The Aqueous Lyophilisate of Alchemilla Kiwuensis Engl. (Rosaceae) Displays Antiepileptogenic and Antiepileptic Effects on PTZ-induced Kindling in rats: Evidence of Modulation of Glutamatergic and GABAergic Pathways Coupled to Antioxidant Properties

Alchemilla kiwuensis Engl. (Rosaceae) (A. kiwuensis) is an herbaceous plant traditionally used by Cameroonians to treat epilepsy and other central nervous system disorders. The present study evaluated the antiepileptogenic and antiepileptic effects of A. kiwuensis (40 mg/kg, 80 mg/kg) following Pentylenetetrazole (PTZ)-induced kindling as well as its sub-chronic toxicity. Following an initial i.p administration of a challenge dose (70 mg/kg), Wistar rats of both sexes received sub convulsive doses (35 mg/kg) of PTZ every other day, one hour after the oral gavage of animals with treatments, until two consecutive stage 4, in all animals of negative control. Seizure progression, latency, duration, and repetition were noted. Twenty-four hours later, animals were dissected to extract their hippocampi. The resulting homogenates were used to evaluate Malondialdehyde, reduced glutathione, catalase activity, GABA, GABA-Transaminase, glutamate, glutamate transporter 2, IL-1β and TGF-1 β. Sub-chronic toxicity was conducted according to OECD 407 guidelines. The lyophilisate of A. kiwuensis significantly increased the latency of seizure appearance, delayed seizure progression and decreased seizure repetition and duration. Biochemical analysis revealed that the lyophilisate significantly increased the catalase activity, reduced glutathione, GABA, glutamate transporter 2 and TGF-1B levels. The lyophilisate equally caused a significant decreased in the GABA-Transaminase activity, malondialdehyde, and IL-1 β levels. There was no noticeable sign of toxicity. A. kiwuensis possesses antiepileptic and antiepiletogenic effects by enhancing GABAergic neurotransmission and antioxidant properties, coupled to modulation of glutamatergic and neuroinflammatory pathways and is innocuous in a sub-chronic model. These justifies its local use for the treatment of epilepsy.

Assessment of the toxic effects of levetiracetam on biochemical, functional, and redox parameters of salivary glands in male Wistar rats

Levetiracetam (LEV) is an anticonvulsant for epilepsy. The toxic effects of this medication in tissues have been associated with redox state imbalance, which can lead to salivary gland dysfunction. Therefore, the current work investigated the effects of LEV on the biochemical, functional, and redox parameters of the parotid and submandibular glands in rats. For this, male Wistar rats (Rattus norvegicus albinus) were randomly divided into 3 groups (n = 10/group): Control (0.9% saline solution), LEV100 (100 mg/kg), and LEV300 (300 mg/kg). After 21 consecutive days of intragastric gavage treatments, pilocarpine stimulated saliva secretion was collected for salivary biochemical analysis. The extracted salivary glands were utilized for histomorphometry and redox state analyses. Our results showed that LEV300 increased plasma hepatotoxicity markers and reduced salivary amylase activity and the acinar surface area of the parotid gland. Total oxidant capacity and oxidative damage to lipids and proteins were higher in the parotid gland, while total antioxidant capacity and uric acid levels were reduced in the submandibular gland of the LEV100 group compared to Control. On the other hand, total oxidant capacity, oxidative damage to lipids and proteins, total antioxidant capacity, and uric acid levels were lower in both salivary glands of the LEV300 group compared to Control. Superoxide dismutase and glutathione peroxidase activities were lower in the salivary glands of treated animals compared to Control. In conclusion our data suggest that treatment with LEV represents a potentially toxic agent, that contributes to drug-induced salivary gland dysfunction.

Morphological, biochemical, and histopathological effects of levetiracetam on pregnant albino rats and their offspring

One of the most widely used medications for epilepsy is the broad-spectrum antiseizure levetiracetam. The study aimed to evaluate the impact of levetiracetam on the bodyweight and liver of pregnant rats and their offspring. The study involved treating the rats during pregnancy and lactation and then examining the pregnant rats and their offspring. Two groups of 40 pregnant rats were created (I, II). Each group was split up into two smaller groups (A, B). About 1.5 mL/day of distilled water was gavaged to the rats in group I, either continuously throughout pregnancy (IA) or continuously throughout pregnancy and 15 days after delivery (IB). Group II rats received 1.5 ml/day of distilled water (containing levetiracetam) either during pregnancy (IIA) or during pregnancy plus 15 days postpartum (IIB). At the end of the work, blood samples were taken from the adult rats, body weight of different groups were recorded, and then, their liver was subjected for histological and morphometric analysis. Levetiracetam treatment showed reduction in the body weight of adult rats and their offspring and pathological changes in their liver. These changes were in the form of distortion of the hepatic architecture, cytoplasmic vacuolation, nuclear changes, and swollen mitochondria with loss of their cristae. Such changes were proved by alteration in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzyme levels of the liver. It is advised to monitor the liver functions continuously when using levetiracetam.

Therapeutic Strategies to Ameliorate Neuronal Damage in Epilepsy by Regulating Oxidative Stress, Mitochondrial Dysfunction, and Neuroinflammation

Epilepsy is a central nervous system disorder involving spontaneous and recurring seizures that affects 50 million individuals globally. Because approximately one-third of patients with epilepsy do not respond to drug therapy, the development of new therapeutic strategies against epilepsy could be beneficial. Oxidative stress and mitochondrial dysfunction are frequently observed in epilepsy. Additionally, neuroinflammation is increasingly understood to contribute to the pathogenesis of epilepsy. Mitochondrial dysfunction is also recognized for its contributions to neuronal excitability and apoptosis, which can lead to neuronal loss in epilepsy. This review focuses on the roles of oxidative damage, mitochondrial dysfunction, NAPDH oxidase, the blood-brain barrier, excitotoxicity, and neuroinflammation in the development of epilepsy. We also review the therapies used to treat epilepsy and prevent seizures, including anti-seizure medications, anti-epileptic drugs, anti-inflammatory therapies, and antioxidant therapies. In addition, we review the use of neuromodulation and surgery in the treatment of epilepsy. Finally, we present the role of dietary and nutritional strategies in the management of epilepsy, including the ketogenic diet and the intake of vitamins, polyphenols, and flavonoids. By reviewing available interventions and research on the pathophysiology of epilepsy, this review points to areas of further development for therapies that can manage epilepsy.

Dietary intake and nutritional status of people with epilepsy: A systematic review

PURPOSE

In people with epilepsy achieving optimal dietary intake may be hampered by psychological and physical comorbidities associated with seizures, medication use, socioeconomic disadvantage and the use of therapeutic diets. This systematic review aimed to evaluate the reported dietary intake and nutritional status of children and adults with epilepsy.

METHODS

A systematic literature search was completed across Ovid MEDLINE, EMBASE and CINAHL (all from inception to 4 November 2021). We included studies that reported dietary intake in adults and children diagnosed with epilepsy compared with local reference ranges, control groups or general populations. Studies using interventions and therapeutic diets were excluded. Risk of bias was assessed using the Study Quality Assessment Tools by the National Heart, Lung and Blood Institute. A descriptive analysis was performed due to the heterogenous nature of the data.

RESULTS

The initial search returned 1214 articles. Full-text screening was completed for 98 studies and 19 studies met eligibility criteria and were included for extraction. These comprised of seven paediatric studies, eight adult studies and four studies that included both adult and paediatric cohorts. Sample size of cases in each study ranged from 17 to 3,220. Vitamin A, C, D and folate were the most frequently reported vitamins. Calcium, iron and zinc were the most commonly reported minerals. Most studies showed that people with epilepsy had poorer dietary intake and nutritional status compared with control groups or reference standards.

CONCLUSION

There were limited studies on dietary intake and nutritional status in people with epilepsy. Most available studies suggested poorer status compared to non-epilepsy controls. The development of a validated dietary assessment tool specifically for epilepsy cohorts would enable comparison of findings across studies, and aid with appropriately tailoring nutrition advice to individuals with epilepsy.

The effect of levetiracetam on depression and anti-oxidant activity in patients with epilepsy

Background: Levetiracetam (LEV) is approved for treating epilepsy. The current evidence shows that LEV can cause behavioral problems such as depression. It is well-known that depression is associated with oxidative stress. Therefore, we conducted this study to assess the influence of LEV on depression severity and anti-oxidant status. Methods: In this prospective longitudinal study, 50 patients with diagnosis of epilepsy on LEV were included. We used Beck Depression Inventory-II (BDI-II) to assess depression severity. The serum levels of zinc and glutathione were measured as anti-oxidant markers. These variables were evaluated at the baseline and 3 months after the commencement of LEV. Results: A total of 30 patients finished the follow-up. Among them, 21 patients were women. The mean age at baseline was 28.76 ± 11.37 (range: 16-68 years). The severity of depression at the last follow-up was significantly higher than the baseline. We observed a decrease in the serum levels of zinc and glutathione, though they were not statistically significant. Conclusion: Our results suggest that LEV can increase the risk of depression in patients with epilepsy. This study also suggests that zinc depletion can be induced through act of LEV. Further studies are needed to validate these findings.

Levetiracetam Mechanisms of Action: From Molecules to Systems

Epilepsy is a chronic disease that affects millions of people worldwide. Antiepileptic drugs (AEDs) are used to control seizures. Even though parts of their mechanisms of action are known, there are still components that need to be studied. Therefore, the search for novel drugs, new molecular targets, and a better understanding of the mechanisms of action of existing drugs is still crucial. Levetiracetam (LEV) is an AED that has been shown to be effective in seizure control and is well-tolerable, with a novel mechanism of action through an interaction with the synaptic vesicle protein 2A (SV2A). Moreover, LEV has other molecular targets that involve calcium homeostasis, the GABAergic system, and AMPA receptors among others, that might be integrated into a single mechanism of action that could explain the antiepileptogenic, anti-inflammatory, neuroprotective, and antioxidant properties of LEV. This puts it as a possible multitarget drug with clinical applications other than for epilepsy. According to the above, the objective of this work was to carry out a comprehensive and integrative review of LEV in relation to its clinical uses, structural properties, therapeutical targets, and different molecular, genetic, and systemic action mechanisms in order to consider LEV as a candidate for drug repurposing.

The Influence of Oxidative Stress on Thyroid Diseases

Thyroid diseases, including neoplasms, autoimmune diseases and thyroid dysfunctions, are becoming a serious social problem with rapidly increasing prevalence. The latter is increasingly linked to oxidative stress. There are many methods for determining the biomarkers of oxidative stress, making it possible to evaluate the oxidative profile in patients with thyroid diseases compared to the healthy population. This opens up a new perspective for investigating the role of elevated parameters of oxidative stress and damage in people with thyroid diseases, especially of neoplastic nature. An imbalance between oxidants and antioxidants is observed at different stages and in different types of thyroid diseases. The organ, which is part of the endocrine system, uses free radicals (reactive oxygen species, ROS) to produce hormones. Thyroid cells release enzymes that catalyse ROS generation; therefore, a key role is played by the internal defence system and non-enzymatic antioxidants that counteract excess ROS not utilised to produce thyroid hormones, acting as a buffer to neutralise free radicals and ensure whole-body homeostasis. An excess of free radicals causes structural cell damage, undermining genomic stability. Looking at the negative effects of ROS accumulation, oxidative stress appears to be implicated in both the initiation and progression of carcinogenesis. The aim of this review is to investigate the oxidation background of thyroid diseases and to summarise the links between redox imbalance and thyroid dysfunction and disease.