Abstracts

Rationale: Rapid onset of action of oral levetiracetam (LEV) was demonstrated through increase in the proportion of seizure-free patients with chronic epilepsy as of the first day of treatment. Since the marketing of the intravenous (IV) formulation, there have been anecdotal reports of its use to abort repetitive seizures and status epilepticus . We tested I.V. LEV in a systematic fashion in acute repetitive seizures in the epilepsy monitoring unit (EMU) setting. Methods: In an ongoing single arm, feasibility study we are studying IV LEV in patients with partial epilepsy admitted to the EMU at Vanderbilt University Medical Center. If a patient has >1 generalized tonic-clonic seizure (GTC), >2 complex partial seizures (CPS), or 1GTC and one or more CPS over 24 hours, 1000mg IV LEV mixed with 100ml normal saline is given as a single dose over five minutes. Subjects are observed for 24 hours. If acute repetitive seizures persist, 2 mg IV lorazepam is used. The primary outcome measure is time to the first seizure after study drug. The secondary outcome measures are proportion of patients requiring rescue medication (IV lorazepam 2mg), proportion of patients with secondarily generalized seizures and EEG changes in the 24 hours after treatment. The study was approved by the Vanderbilt IRB. All participating patients signed a consent form prior to being enrolled. Results of the first 30 enrolled patients, eight of whom received the drug are presented. Results: Eight patients received IVLEV after meeting the above criteria. Time to LEV infusion from time of meeting criteria was 8 mins to 14 hrs (median of 44 minutes). Three of the subjects did not have seizures for 24 hours of observation after IV LEV, 2 had a seizure at 17 hours, and one at 5 hours and 2 in less than 2 hours after IV LEV. Two subjects had GTC seizures after IV LEV, but only CPS occurred after IV LEV in the others, even though three subjects had history of GTC seizures. The time to 1st seizure after IV LEV (5 subjects) was 45 minutes to 17 hours (median of 5 hours), time to SGTC were 5 hrs and 17 hours. Two patients received rescue lorazepam IV. One had no further seizures and one had more seizures after that. Improvement in interictal discharges on EEG was seen in two patients, worsening was noted in one, and no change was noted in the rest. One patient reported somnolence, but no other adverse experiences were reported. Conclusions: IV LEV was well tolerated in EMU patients who had >1 GTC or >2 CPS seizures. It appeared to stop seizures in 3 of eight patients. In two other patients who had their first seizure beyond 12 hours, medication wear off might be have been a contributing factor for seizure recurrence. Additional patient enrollment will provide further insight on the use of IV LEV to stop seizures in the EMU.