Abstract
Background
Levetiracetam (LEV) is a newer generation antiepileptic drug with unique anticonvulsive mechanism of action. It has been reported to cause daytime sleepiness in 4–15% of patients with epilepsy.
Methods
We studied the effect of 2000 mg LEV monotherapy on daytime sleepiness over a 3-month period in patients with epilepsy. The subjective assessment of daytime sleepiness was made through Epworth sleepiness scale (ESS), and the objective assessment—through four naps MSLT. Both procedures were performed at baseline and after a 3-month period of LEV treatment. The dynamics in ESS score was measured as a shift from normal to excessive daytime sleepiness or vice versa. We studied two MSLT variables—mean sleep latency for all four naps and sleep stage. The dynamics in the mean sleep latency from baseline to the end of the third month of LEV treatment was also measured.
Results
Twenty five patients participated in our study. The subjective and objective assessment of daytime sleepiness matched in only five of them. In none of the patients, ESS score was worsened after therapy. There was no statistically significant difference between the subjective assessment at baseline and after therapy (p = 0.250). There was no statistically significant difference between the objective assessment of daytime sleepiness at baseline and after therapy (r = 0.13). The patients with prolonged mean sleep latency reached a deeper sleep stage after therapy. The daytime sleepiness assessment correlated only with seizure frequency—patients with > 1 seizure a year had less variation in the degree of daytime sleepiness, i.e. more constant mean sleep latency.
Conclusion
LEV 2000 mg/day does not worsen the subjective and the objective assessment of daytime sleepiness in patients with newly diagnosed or untreated epilepsy.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs41782-023-00235-6/MediaObjects/41782_2023_235_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs41782-023-00235-6/MediaObjects/41782_2023_235_Fig2_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs41782-023-00235-6/MediaObjects/41782_2023_235_Fig3_HTML.png)
Similar content being viewed by others
Data availability
The authors declare the availability of data associated with the study.
References
Lynch BA, Lambeng N, Nocka K, et al. The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci USA. 2004;101:9861–6.
Bazil CW. Sleep and epilepsy. Semin Neurol. 2002;22:321–7.
Mendez M, Radke RA. Interactions between sleep and epilepsy. J Clin Neurophysiol. 2001;18:106–27.
De Weerd A, de Haas S, Otte A, Kasteleijn-Nolst Trenite D, van Erp G, Cohen A, de Kam M, van Gerven J. Subjective sleep disturbance in patient with partial epilepsy: a questionnaire-based study on prevalence and impact on quality of life. Epilepsia. 2004;45:1397–404.
Ayala-Guerrero F, Mexicano G, Gonzalez V, et al. Effect of oxcarbazepine on sleep architecture. Epilepsy Behav. 2009;15:287–9.
Marzec M, Edwards J, Sagher O, Fromes G, Malow BA. Effects of vagus nerve stimulation on sleep-related breathing in epilepsy patients. Epilepsia. 2003;44:930–5.
Sadek A, French JA, et al. Levetiracetam. In: Shorvon S, Perucca E, Fish D, et al., editors. The treatment of epilepsy. Malden: Blackwell Science; 2004. p. 187.
Placidi F, Scalise A, Marciani MG, et al. Effect of antiepileptic drugs on sleep. Clin Neurophysiol. 2000;111(suppl 2):115–9.
Legros B, Bazil CW. Effects of antiepileptic drugs on sleep architecture: a pilot study. Sleep Med. 2003;4:51–5.
Cho YW, Kim DH, Motamedi GK. The effect of levetiracetam monotherapy on subjective sleep quality and objective sleep parameters in patients with epilepsy: compared with the effect of carbamazepine-CR monotherapy. Seizure. 2011;20:336–9.
Cicolin A, Magliola U, Giordano A, et al. Effects of levetiracetam on nocturnal sleep and daytime vigilance in healthy volunteers. Epilepsia. 2006;47:82–5.
Yilmaz H. Comparison of motor activity and sleep in patients with complex partial seizures on levetiracetam treatment and a group of healthy subjects. Behav Neurol. 2007;18:165–70.
Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the international league against epilepsy: position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58:522–30.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.
Carskadon MA, Dement WC, Mitler MM, et al. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep. 1986;9:519–24.
Carskadon MA, Dement WC. Sleep tendency: an objective measure of sleep loss. Sleep Research. 1977;6:200.
Bell C, Vanderlinden H, Hiersemenzel R, Otoul C, Nutt D, Wilson S. The effects of levetiracetam on objective and subjective sleep parameters in healthy volunteers and patients with partial epilepsy. J Sleep Res. 2002;11(3):255–63.
Zhou JY, Tang XD, Huang LL, et al. The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patients with partial epilepsy. J Clin Neurosci. 2012;19:956–60.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chaneva, O., Viteva, E. & Yaneva, A. Objective and Subjective Assessment of the Effect of Levetiracetam on Daytime Sleepiness in Patients with Epilepsy. Sleep Vigilance 7, 97–103 (2023). https://doi.org/10.1007/s41782-023-00235-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41782-023-00235-6