Levetiracetam Effect on Hematological Indices in children with Idiopathic Epilepsy

Background: Levetiracetam (LEV) is a well-known broad-spectrum antiepileptic drug, approved by FDA, for proper and effective control of both focal and generalized epilepsy. It exerts its effect by binding to synaptic vesicle glycoprotein 2A (SV2A) protein which mediates calcium dependent vesicular neurotransmitter release. Due to the need for long-term use, several studies have discussed LEV effect on hematological parameters. They have noted some case reports of pancytopenia, thrombocytopenia and lymphopenia. Methods: This prospective cohort study involved fifty-eight participants divided in two groups; the first one (the case group) included children who were diagnosed idiopathic epilepsy on levetiracetam as monotherapy with six months follow up while the other group (the control group) had healthy children of the same age range. Hematological indices (complete blood count (CBC) and coagulation profile (prothrombin time, partial thromboplastin time and international randomized ratio (pT, pTT, INR)) were compared among cases before and six months after LEV. Results: Of 29 cases, 10 were female and 19 were male with ranging age between 1 to 14 years. Our study showed that absolute neutrophilic count (ANC) has significantly declined after six months of LEV monotherapy, while other parameters (Hb: Hemoglobin, MCV: Mean corpuscular volume, MCH: Mean corpuscular hemoglobin, lymphocytes, platelets pT, pTT, INR) remained statistically unchanged. Conclusion: In children with idiopathic epilepsy, LEV monotherapy may induce significant change in hematological indices mainly on ANC especially on long term.