Intranasal Seletracetam in a Patient with Reading Epilepsy: First-in-Human Use to Prevent Reflex Seizures.

Koepp, Matthias J; Poppert, Kai-Nicolas; Felder, Thomas; Thomschewski, Aljoscha; Lafenthaler, Sandra; Klein, Pavel; Rotenberg, Alexander; Löscher, Wolfgang et al. · Ann Neurol · 2026

case_report · Level V

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Abstract

We report the first human use of intranasal seletracetam (SEL) to prevent reflex seizures. A patient with epilepsy with reading-induced seizures on levetiracetam (3,000 mg/day) continued to experience reading-induced focal seizures with preserved consciousness. Detectable in serum within 2 minutes of intranasal administration, 30 mg seletracetam delayed seizure onset from 1:56 (placebo) to 4:17 minutes post-stimulus onset. A second 30 mg dose fully prevented seizures during 25 minutes of reading. Electroencephalogram (EEG) spike-frequency declined dose-dependently (3.1/min at placebo to 1.6/min after second dose), with reduced spike-propagation on magnetoencephalography (MEG). Our findings support SEL as a promising non-benzodiazepine acute seizure prevention and provide insight into reflex seizure dynamics. ANN NEUROL 2026;99:535-539.

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