Lack of efficacy of levetiracetam in oromandibular and cranial dystonia

Abstract

ObjectiveTo determine the efficacy of levetiracetam in oromandibular or cranial dystonia. MethodsWe recruited seven subjects with oromandibular or cranial dystonia. Five completed the study, median age was 71years (range 42-79years), median disease duration was 12years (range 2-30years). Participants were randomized to receive levetiracetam or placebo and were then crossed over. They titrated up to a total daily dose of 4000mg or the maximum tolerated dose over 3weeks and maintained that dose for another 3weeks. The primary endpoint was the percent change of the eyes, mouth, speech, and swallowing Burke-Fahn-Marsden (BFM) subscores from baseline to weeks 6 and 14. Additional endpoints included the BFM subscore at weeks 3 and 11, and the global dystonia severity (GDS) subscore at weeks 3, 6, 11, and 14, as well as all adverse side effects. ResultsThe mean percent increase in the BFM subscore (placebo: 31.25%, levetiracetam: 12.16%) was not significantly different between the two arms according to the Friedman analysis. The Wilcoxon signed-rank test showed that these percent changes were not significant, indicating that there was no statistical clinical worsening in either arm. The mean percent change of the BFM subscore at weeks 3 and 11 and the mean percent change of the GDS subscore at weeks 3, 6, 11, and 14 were not significantly different between the two arms, and the Wilcoxon signed-rank test did not show statistical significance. ConclusionLevetiracetam does not appear to be efficacious in patients with oromandibular or cranial dystonia.