Abstracts

Despite the advances made in treating epilepsy it is estimated that between 35-50% of patients continue to experience breakthrough seizures even after a trial of 3 or more different antiepilepsy drugs (AEDs). Levetiracetam (LEV) is a unique drug which still has an unclear mechanism of action. It has a different profile than most AEDs in animal models also. Of all the newer AEDs, it has the least patient exposures worldwide. We present the results of our experience in using LEV as therapy in patients with medically intractable epilepsy.
Patients at Penn State[apos]s Milton S. Hershey Medical Center were evaluated for therapy with LEV in the Adult Epilepsy Clinic. Patients were candidates for therapy if they had a history of uncontrolled seizures, were able to keep an accurate count of their seizures, had either focal or primary generalized seizures, were between the ages of 16 - 85 years, and had no history of renal disease. Patients were treated for at least 6 months with visits at months 0, 3, and 6. Whenever possible, LEV serum levels were obtained.
At the end of the study, 141 patients were treated with LEV. Twenty-seven patients were excluded due to failure to take medication as directed, inability to keep accurate seizure diaries, or were lost to follow-up. This left 114 patients for analysis. Dosages of LEV ranged from 500 mg/day to 6,000 mg/day. Of these patients, 35 (31%) became seizure-free following LEV therapy. An additional 16 patients (14%) had a 75% reduction in seizures, 17 patients (15%) had a 50% reduction in seizures, 39 patients (34%) had no change in seizure frequency, and 7 patients (6%) discontined therapy due to adverse events. Behavior-related side effects were reported in 26 patients, 3 of which discontined LEV due to this side effect. One patient developed a rash on LEV. Two sub-groups of patients that responded favorably to LEV were patients with recurrence of seizures following temporal lobectomy and patients with head trauma. Twenty-six patients of the 114 were mentally handicapped. Only 8% of this group became seizure-free with LEV therapy. We did not see a higher incidence of behavior-related side-effects in this population, however.
Levetiracetam proved to be effective in our intractable patients. Of our patients, 60% showed a reduction of seizures greater than or equal to 50%, with 31% becoming seizure-free. Only 7 patients discontinued due to adverse events. Behavior-related side-effects were seen in 26 patients (23%), but only 3 patients discontinued due to this adverse event. In addition to its efficacy, the pharmacokinetic profile of LEV also makes it an attractive option in patients with uncontrolled seizures.