Odds of Keppra Working for Partial Epilepsy - Pretty damn good. 20-30% of patients with refractory epilepsy had 50% or greater reduction of weekly seizures in the approval trials. Seeing that we are looking at people who’ve failed multiple meds, and who have multiple seizures WEEKLY, those are decent odds. According to one support type site’s med listing, in the UK Keppra is what they try for partial epilepsy after you’ve failed a few meds.  Here's a small, year-long study where two thirds of the people taking Keppra as monotherapy had as good or better seizure control than previous meds.  Here's a big study showing Keppra reducing seizures in the first day of treatment.  Keppra may be the drug of choice for late-onset partial seizures.  Geez, even if freaking epilepsy surgery fails, Keppra is the go-to drug.  "..and may have implications for its use before surgical intervention."  Oh, thanks, doc!  Glad you thought about that beforehand!

Odds of Keppra working for Generalized Epilepsy - Looks good so far. We couldn't find much in the way of trials or studies using Keppra as monotherapy in adults for generalized seizures.  Most of the time it's using Keppra as on add-on, such as this one study of over 150 people where 40 people in it became seizure-free, with 25 of them on 1000mg a day or less.  We did find one for idiopathic (i.e. you were born with it) myoclonic, tonic-clonic and/or absence seizures where 42 out of 55 people had either a 50% more reduction in seizures, or became flat-out seizure-free.  As for case studies, they're along the lines of  three people with refractory epilepsy becoming seizure free on Keppra monotherapy.  I found a single study for Lennox-Gastaut syndrome where out of 6 patients, 4 had 100% reduction in myoclonic seizures, 2 had 50% reduction in their atonic seizures, and 4 had 100% reduction in tonic-clonic seizures. That reads as fan-fucking-tastic to me.   Finally a woman with negative myoclonus has become seizure-free on Keppra. Go figure. Keppra’s worked better for these people than for some of the people with partial epilepsy in the trials!

Odds of Keppra Working for Migraines - Chances are Keppra will at least help. Oddly, it was easier to find studies on pediatric migraines. Large percentages (like, 2/3 large) are reporting reductions in number and/or severity. And of course they like the (lack of) side effect profile.

Odds of Keppra working for Neuropathic Pain - Looks promising. One study showed Keppra working as an adjunct to help cancer patients reduce pain and opiates. Other small case studies show Keppra as effective, too, but larger scale studies are elusive.

Odds of Keppra Working for Bipolar-Keppra will stop any and all manias dead in their tracks, either as an add-on medication (added to unspecified meds of 7 out of 16 manic or cycling people), or all by itself (one of several case reports, but this person had tried everything).  This is THE drug for happy-happy-joy-joy manias. Not as harsh as Zyprexa, not a whole lot slower, and Keppra will bring you back to earth-just so long as you don’t crash into the pit of despair, all is well.   Keppra has been reported to help people with rapid cycling as well.

Keep in mind who sponsors the study, as it will tend to make the results more favorable for the med in question (on average 3.6 times more likely, according to a Yale study).   Please see the page on how to read this page for an explanation of the various scales and ratings used by the studies.

One of the main problems we've found with studies that compare Keppra to others meds is there is a great scarcity of them.  At least ones where Keppra is actually compared with another med head to head.  The majority we could find are meta-analyses - where someone got a grant to study other studies and draw conclusions from that.  Sort of what we do here.  For free.  We find this surprising, because in the individual studies and case reports referenced above, as well as the various metaanalyses, Keppra scores better than all other anticonvulsants.  So why aren't there more head-to-head studies against other meds?

Studies Comparing Keppra with Other Meds for Epilepsy

Vagus Nerve Stimulation vs. Anticonvulsant Cage Match!  In a large study of almost 900 people, about a quarter of them were able to reduce their meds.  This is the only study we've found so far where Keppra hasn't had a significant impact in reducing seizures as an add-on.  However Keppra wasn't one of the popular meds that people were able to discontinue with VNS therapy.

Keppra vs. Lamictal vs. Topamax  In the field at a UK district hospital in York. Thirteen percent of an unknown number of people became seizure free and approximately one-third had a reduction of greater than 50% in their seizures.  "All three AEDs were most successful at treating primary generalized epilepsy and least successful with symptomatic generalized epilepsy."  While Keppra and Topamax were the most effective, Topamax sucked the most. 

Anticonvulsant Cage Match! Assessing quality of life issues, cost effectiveness and, oh, I don't know, how well they work.  This meta-analysis conducted by the University of York in the UK plowed through 1,098 studies published up through September 2002.  Of those only 212 met their criteria of being relevant enough for consideration - the studies lasted long enough, were randomized, reports of side effects weren't vague, the usual stuff that we complain about in these studies.  But they also wanted old people and pregnant women included.  They were also looking for one more thing important to them: how much everything cost.  The aim was, "To examine the clinical effectiveness, tolerability and cost-effectiveness of Neurontin (gabapentin), Lamictal (lamotrigine), Keppra (levetiracetam), Trileptal (oxcarbazepine), Gabitril (tiagabine), Topamax (topiramate) and Sabril (vigabatrin) for epilepsy in adults."  Especially when stacked up against the older meds.  When taking into consideration cost, inclusion of the elderly and pregnant women, and the number of really good long-term studies published these days, it's little wonder that the older meds come out on top.

Keppra vs. Topamax - which sucks more?  No, really, that's all they wanted to know.  The loser - Topamax (topiramate).  Captain Obvious to the Netherlands: "Duh!"

Anticonvulsant Cage Match! This time for Landau-Kleffner syndrome in Spain.  Lamictal (lamotrigine) vs. Depakine (valproate sodium) vs. Trileptal (oxcarbazepine) vs. Keppra (levetiracetam) vs. Topamax (topiramate) vs. Zarotin (ethosuximide) vs. Frisium (clobazam) vs. Ospolot (sulthiame) vs. corticoids vs. ACTH.  The winner in Madrid:  Lamictal (lamotrigine).

Keppra vs. Trileptal vs. Zonegran vs. remacemide.  A meta-analysis of placebo-controlled trials where these drugs were used as add-ons for treatment-resistant, localized seizure-disorders.  Keppra was the most successful and sucked the least.  Followed by Zonegran (zonisamide) and Trileptal (oxcarbazepine).  Remacemida is an NMDA channel blocker, the sort of thing that is typically used to treat Huntington's, Parkinson's and/or Alzheimer's.  As Keppra also deals with glutamate, and NMDA is bleeding-edge stuff for epilepsy these days, I guess that's why it's being evaluated for refractory seizures.  Alas, Keppra was the least effective and sucked the most in this study. 

Studies Comparing Keppra with Other Meds for Bipolar Disorder 

Anticonvulsant Cage Match!  National Institute of Mental Health's Bipolar Research Center at Case Western Reserve University School of Medicine decided to do a meta-analysis of compare the popular anticonvulsants available in the US for their efficacy in dealing with bipolar disorder.  The results:  Depakote (divalproex sodium) and Tegretol (carbamazepine) are your top anti-manics, while Lamictal (lamotrigine) is the only true mood stabilizer of the bunch, with a particularly robust antidepressant effect.  All the rest do bupkiss.  Because there haven't been enough studies published on them is why.

Lithium vs. Anticonvulsants in Suicide Cage Match! - Lithium has conflicting studies if it does or doesn't have a positive affect on suicide rates among the bipolar community.  There's the well-known, larger meta-analysis indicating that lithium can help prevent suicide.  But there's also a smaller, but longer-lasting study in which lithium therapy actually increased the suicide rate.  That's the world of research for you.  Anyway, this study tracked the suicidal ideations of bipolar people anywhere from one to twenty-five (!) years treated with any one of lithium,  Convulex (valproate sodium), Tegretol (carbamazepine), Trileptal (oxcarbazepine), Keppra (levetiracetam), Topamax (topiramate) or Lamictal (lamotrigine).  Nobody offed them self.  Only people taking Lamictal (lamotrigine) had statistically significant lower rates of suicidal ideation.  Everyone else tended to think about an early exit more than those people taking lithium.

Studies Comparing Keppra with Other Meds for Neuropathic Pain

Keppra vs. Trileptal vs. Topamax vs. Zonegran - Basically if you can't use Tegretol (carbamazepine) or Neurontin (gabapentin), Topamax (topiramate) works the best but Keppra is by far the safest and sucks the least.