The effect of levetiracetam on tremor severity and functionality in patients with multiple sclerosis

Background Multiple sclerosis (MS) intention tremor is a disabling symptom, which is difficult to treat. Objectives To investigate the effects of levetiracetam, an antiepileptic drug, on tremor severity and related functionality in MS. Methods A randomized, double-blind, placebo-controlled, cross-over study examined the effects of 6 weeks of oral levetiracetam administration (starting dose = 250 mg/day, maximal dose = 2000 mg/day) in 18 MS patients with disabling intention tremor. Primary outcome was Fahn’s Tremor Rating Scale (FTRS) A&B. Secondary outcome measures were the nine-hole peg test, patient’s opinion rated with the visual analog scale, FTRS C, and an activities of daily life questionnaire and validated tremor indexes derived during the performance of a digitized spiral drawing task and a wrist step-tracking task. Repeated measures analysis of variance and Friedman tests were applied. Results In all, 14 patients completed the trial. Maximal dose intake ranged from 1000 to most commonly 2000 mg, depending on patients’ tolerance level. No significant effects of levetiracetam were found for any outcome measure. Further analyses on subgroups with different tremor severity showed no differential effects. Eight patients reported adverse events such as fatigue and stomach ache. Conclusions Levetiracetam intake of 2000 mg/day did not affect tremor severity or functionality in patients with MS.