Abstracts

RATIONALE: We report our experience in the use of levetiracetam and zonisamide in an unselected group of children with intractable epilepsy. To date our patients have been followed for at least 3 months. Further followup will be obtained prior to presentation.
METHODS: Children with intractable epilepsy of various types were considered for treatment with either levetiracetam or zonisamide. The choice of agent was arbitrary, unless there was a history of sensitivity to sulfa medications, in which case zonisamide was avoided. Charts were reviewed and parents interviewed to ascertain seizure frequency before and after the introduction of the new agent, as well as the presence of side effects.
Levetiracetam group: 26 patients (13 boys), 20 months to 24 years of age (median age 5 years, 4 months). 1 was on 4 additional drugs, 2 on 3 drugs, 12 on 2 drugs, 8 on one drug, and 2 on levetiracetam monotherapy.
Zonisamide group: 24 patients (14 girls), 9 months to 16 years of age (median age 6 years). 2 were on 4 additional drugs, 4 on 3 drugs, 8 on 2 drugs, 6 on one drug, and 3 were on zonisamide monotherapy.
RESULTS: Levetiracetam: At three months 24 of 26 patients remained on medication - 2 discontinued due to lack of efficacy. For those still on treatment the dose range was 13.4 to 98.7 mg/kg (mean 43.6 mg/kg). Of the remaining 24 patients, 12 patients had [gt]50% reduction in seizure frequency, 6 of whom were seizure free. Three patients were on levetiracetam monotherapy, one of whom was seizure-free.
Adverse effects included: mood swings (5), lethargy (5), decreased appetite (2) and drooling (1).
Zonisamide: At three months 17 of 24 patients remained on the medication - 3 discontinued due to adverse effects and 4 due to lack of efficacy. For those still on treatment the dose range was 3.4 to 30.4 mg/kg (mean 13.4 mg/kg). Of the 17 remaining on treatment, 13 patients had [gt]50% reduction in seizure frequency, 6 of whom were seizure free. 3 patients were on zonisamide monotherapy, 2 of whom were seizure-free.
Adverse effects included: Hyperthermia (1), Severe rise in lithium level (1), hypercholesterolemia (1), lethargy (5), hyperactivity (2), GI upset (1), communication difficulty (2).
CONCLUSIONS: Levetiracetam and Zonisamide improved seizure control in a group of children with intractable epilepsy.
No patients on levetiracetam had the medication withdrawn due to adverse effects. 3 patients on zonisamide had the medication withdrawn due to concern about possible side effects: a sharp increase in lithium level, marked hypercholesterolemia, and hyperthermia.
Further studies to define the indications, dosing, and side effect profile of these agents in children are needed.
Disclosure: Consulting - Elan pharmaceuticals, UCB Pharma. Honoraria - Elan pharmaceuticals, UCB Pharma. Other - Elan pharmaceuticals, UCB Pharma: unrestricted educational grants.