Abstracts

RATIONALE: To compare the efficacy and tolerability of topiramate and levetiracetam in adult patients with intractable epilepsy in a practice setting.
METHODS: The case files of the initial forty patients that were treated with levetiracetam were reviewed and information about seizure frequency and drug tolerability were obtained. Demographic information, seizure type, etiology, frequency and concomitant treatment were also abstracted. Patient files were reviewed sequentially and a matching number of patients treated with topiramate were identified and the same information was abstracted. Efficacy was determined by percent seizure reduction with subjects divided into four groups; 0-25%, 25-50%, 50-75% and greater than 75% reduction in seizure frequency. Tolerability was determined by the number of patients in whom treatment was discontinued due to adverse effects. Results were compared using Chi squared statistics with the results unknown.
RESULTS: There were forty patients in each treatment group. Groups were similar in age and sex. Partial seizures were the most frequent seizure type with 75% in each group. The predominant etiology was cryptogenic in both groups. Average baseline seizure frequency was similar with 5 seizures/month in the levetiracetam group and 4.3 in the topiramate group. Each drug was initially added to an average of 1.8 drugs in each group. Average length of follow-up was four month for the levetiracetam group and significantly longer for the topiramate group. The mean levetiracetam dose was 1350mg/day and the mean topiramate dose was 300mg/day. Results showed that patients treated with levetiracetam did significantly better (p [gt] .001) than those treated with topiramate (see table).[table]There was no significant difference in tolerability with approximately 25% of each group discontinuing treatment because of adverse effects. The most common reasons for discontinuance were fatigue and drowsiness in both groups.
CONCLUSIONS: This practice based comparative study of the efficacy and tolerability of levetiracetam and topiramate indicates that levetiracetam is likely to be more effective than topiramate in adults with predominately intractable partial seizures. Tolerability of the two drugs was not significantly different as determined in this study.
Disclosure: Grant - Pfizer, Glaxo SmithKline. Equity - Abbott, Johnson & Johnson. Consulting - Abbott, Novartis, Pfizer, Glaxo SmithKline, UCB Pharma, Ortho-McNeil. Honoraria - Abbott, Novartis, Pfizer, Glaxo SmithKline, UCB Pharma, Ortho-McNeil.