Abstracts

Rationale: To review in a retrospective fashion the safety and efficacy of intravenous levetiracetam in adult and pediatric patients who were hospitalized and acutely ill. Methods: We reviewed a total of 20 patients who were given intravenous levetiracetam for seizure prophylaxis or seizure management since October 2006. Of these patients, the data from 7 patients were preliminarily analyzed. Three patients out of 20 were pediatrics patients. We have limited our analysis to hospitalized and acutely ill patients.Results: Adults: Of the 20 patients reviewed, we have identified 7 acutely ill adult patients who were treated with intravenous levetiracetam during their hospitalizations. Of the patients analyzed three patients with structural brain lesions (2 CVA, 1 subarachnoid hemorrhage) had focal electrographic discharges on EEG prior to the initiation of intravenous levetiracetam treatment. These patients had normalization of their EEG after receiving the medication. Two patients did not have EEGs performed prior to receiving intravenous levetiracetam. Two patients had history of congenital brain anomalies with refractory partial epilepsy and had an increased seizure frequency prior to admission. These patients were noted to have had decreased seizure frequency after initiation of intravenous levetiracetam. None of the seven patients developed adverse effects while on the treatment. There were no deaths reported in the treated individuals. The two patients with congenital brain anomalies returned to skilled nursing facility with improved seizure control. One of the stroke patients went to hospice care. Four patients went to subacute rehabilitation facility. All patients were continued on oral levetiracetam after discharge from the hospital. Children: Three pediatric patients who had been treated with intravenous levetiracetam during their hospitalizations were identified and reviewed. One patient was placed on intravenous levetiracetam secondary to seizures after being diagnosed with posterior leukoencephalopathy while on chemotherapy. The patient was unable to tolerate oral medication and had no further seizure episodes or adverse reactions. Two other critically ill pediatric patients with focal onset seizure episodes and abnormal EEGs showing focal slowing had no further seizures on levetiracetam. However the EEGs continued to show persistent focal slowing without neuroimaging correlate. None of the pediatric patients had any adverse events noted while on intravenous levetiracetam. Conclusions: Intravenous levetiracetam has been used at our facility since October 2006 and has been used in several adult and pediatric patients with varied neurologic insults. It has shown to be effective in managing seizures and has had no noted side effects. Further analysis of our clinical experience in patients placed on intravenous levetiracetam is on-going and may provide further insight into the efficacy for seizure management in the hospitalized and acutely ill.