Abstracts

Rationale: In order to assess titration effects of levetiracetam (LEV) in patients with focal or generalized epileptic seizures, we applied a novel method that allows for temporally fine-grained monitoring of cognitive performance as well as subjective well-being using hand held computers.Methods: Twenty patients recruited in the outpatient-clinic of the epilepsy center took part in this pilot study, 10 were newly medicated with LEV, the other 10 patients served as a control group in which medication was held constant. Differences between groups were analyzed regarding self-rated cognitive condition, psycho-physical condition, aggressiveness, and cognitive test performance by applying a 2-back working memory task assessed 3 times a day (morning, early afternoon, evening) over the course of 6 days. The first day served as a baseline with no add-on medication, on the subsequent days LEV was introduced as follows: 250 - 0 – 250 mg (day 1), 500 - 0 – 500 mg (day 2), 1000 - 0 – 1000 mg (during days 3 to 5).Results: Results revealed a significant group difference in self-rated aggressiveness (p<0.05), which was higher in the LEV group in the early afternoon across days. Furthermore, control patients' cognitive performance significantly improved in the morning over the course of days compared to LEV patients, in which morning test performance was rather stable. Beyond proving feasibility of this novel method of patient monitoring, we were able to detect early effects during titration of LEV on (1) subjective aggressiveness depending on time of day and (2) changes in working memory performance over the span of days.Conclusions: We hereby emphasize the unique opportunities for patient monitoring and counseling provided by this novel method.