Abstracts

Levetiracetam is a promising anti-epileptic drug in childhood epilepsy, with proven efficacy both in partial (Glauser 2002; Wheless 2002) and generalized seizures (Lagae, 2003). We evaluated the side effects of levetiracetam in a cohort of 39 children with refractory epilepsy. Since alertness, communication, interaction and behaviour are important issues in the quality of life in children with refractory epilepsy and mental retardation, special attention was paid to these particular items.
In 39 children with seizures that were refractory to at least 1 AED, levetiracetam was introduced as add-on medication. Levetiracetam dosage started at 10mg/kg/day with increases every 4-7 days of 10mg/kg up to a maximum of 60 mg/kg/day. Maximum dosage depended on individual efficacy and tolerability. In the first 12 weeks, baseline AEDs remained unchanged. At 16-20 weeks after introduction, we assessed both efficacy and side effects, using a standardized questionnaire.
The median age of the patients was 5 years (range 5 months-16 years). 30/39 children were on 2 or more AEDs at the time of inclusion. Epilepsy syndromes included West syndrome (n=2), Lennox Gastaut syndrome (n=7), cortical malformations (n=9), postlesional epilepsy (n=3). 34/39 had a moderate or severe mental retardation. The median levetiracetam end dosage was 34 mg/kg/day (range 10-60 mg/kg/day). Overall, 40% of the children had a seizure reduction of [gt] 50%. Three patients became seizure free. At 16 weeks, 31/39 children were still taking levetiracetam. Side effects were rare: somnolence (n=2), aspecific headache (n=1), increased behavioural problems (n=2). In only 1 patient, this was the cause of early withdrawal of levetiracetam. These 5 patients were all on a levetiracetam dosage [gt] 40mg/kg/day. In 9 children, the parents reported a significant increase of alertness, making communication and interaction with these children clearly better. This positive effect was not related to levetiracetam dosage or control of the seizures. In 4 of these 9 children, the parents decided to continue the medication solely because of this positive side effect, and despite a relatively poor seizure control. In 13 children the parents reported a better behaviour, again not related to seizure control or levetiracetam dosage.
We conclude that levetiracetam has a positive efficacy and safety profile in children with refractory epilepy syndromes. In a substantial percentage of the children a clear positive effect was reported on alertness and behaviour, thereby increasing interaction and communication.