Abstracts

RATIONALE: Levetiracetam (LEV) has a unique preclinical profile separating it from other antiepileptic medications (AEM). LEV may benefit children who have failed to respond to previous AEM treatment. However, little is known about the use of LEV in children [lt]12 years of age. We have reviewed our records and report our experience on dose, efficacy and adverse side-effects of LEV in children.
METHODS: Charts were randomly selected until 50 children meeting the following criteria were found: 1) age [lt]12 y.o.; 2) refractory epilepsy; 3) at least six months follow-up after initial treatment with LEV. Charts were then reviewed for demographics, seizure type/frequency, epilepsy syndrome, dose and titration rate of LEV, efficacy, adverse side-effects AE, previous/current AEMs and etiology of seizures.
RESULTS: 30 girls, 20 boys, age 1-11 y.o. (median 6), were treated with LEV, initial dose 3.7-22mg/kg/day (median 9). The maximum dose was 7.3-100 mg/kg/day (median 51, mean 46). All had symptomatic epilepsy, failed to respond to 1-15 previous AEM (median 8, mean 7), and most had partial onset seizures. Children with Lennox-Gastaut (3), Landau Kleffer (3), Epilepsia Partialis Continua, (1), and infantile spasms(1), were included. Efficacy: 8 were seizure free, median dose 44 mg/kg/day, had failed a median of 5 previous AEM. 4 of these children have been transitioned to LEV monotherapy. An additional 6 children had [gt]50% decrease in seizure frequency, 4 of these have[gt]75% decrease in seizures. Nineteen children have continued LEV treatment with [lt]50% improvement in seizure control, but other benefits. Improvements were seen in partial onset seizures, atypical absence, tonic, tonic-clonic, and myoclonic seizures. Eighteen children have discontinued LEV, 8 for lack of efficacy (median dose 56 mg/kg/day), and 10 for AE. Of 10 discontinuations for AE, 9 were for adverse behavior (median dose 50 mg/kg/day). Six of 9 had a positive history of behavior problems and one was seizure free. One child discontinued due to rash. There were no systemic AE.
CONCLUSIONS: LEV demonstrated efficacy and tolerability in children with refractory epilepsy. All seizure types responded. Almost one of every 6 refractory patients became seizure free.
Disclosure: Salary - None; Grant - UCB Pharma - Investigational Studies; Equity - No; Consulting - Yes - Frank J. Ritter, M.D.; Ownership - No; Materials - No Stock - No; Royalties - No; Honoraria - Mary C. Gustafson, Pharm.D., Frank J. Ritter, M.D., Michael D. Frost, M.D.; Other - None