Abstracts

Rationale: Intravenous antiepileptic medication (AEM) alternatives for treating neonates and critically ill infants are needed. LEV IV is available, but little is known about its use in this age group. We review our experience with every dose of LEV IV administered to children <24-months old at Children's Hospitals and Clinics, St. Paul, MN. Most were critially ill, in NICU or PICU. It is unlikely that a formal controlled study of LEV IV in this group of patients will be performed. We present a consecutive series to provide information. Methods: After IRB approval, patients were identified from computerized pharmacy records, inclusion criteria for LEV IV and age <24-months. A chart audit of each patient for demographics, indication, seizure etiology, EEG, MRI, previous AEM, dose of LEV IV, efficacy, safety, and tolerability was performed. Results: Fifty-seven individuals (557 doses LEV IV) were identified. The median dose was 30mg/kg/day (range 4-105). LEV IV concentration was 30mg/ml, usually given over 15 minutes (range 5-30 minutes). Forty-five patients were new exposures to LEV, age: 18 neonates, 10 (1-3 mo.), 12 (4-12 mo.), 5 (13-24 mo). Of these 45, 7 were given LEV IV for seizure prophylaxis following neurosurgery, head trauma, or infection. Thirty-eight were given LEV IV to treat seizures/epilepsy. Most had failed treatment with other IV AEMs. Eighty-four percent had abnormal EEG/MRI. Etiologies were hypoxic/ischemia, stroke, trauma, cortical dysplasia, infection, tumor, other. Efficacy: Fifty-five percent, 21/38 became seizure free after getting LEV IV, including 10/18 neonates. Safety: No change in vital signs. One reported phlebitis. Tolerability: 6 lethargy/sleepy, 2 irritability. There were 4 deaths, not related to LEV IV. Twelve patients received LEV IV to substitute for their usual enteral doses of LEV. They could not take oral LEV due to surgery, illness, or gastrointestinal problems. They all maintained seizure control during IV LEV. Conclusions: Our experience suggests that LEV IV to treat seizures in the very young, neonates <28 days old, and infants 1-24 months, who were critically ill, appears to be effective, well tolerated and safe. The majority of these patients had failed other IV AEMs. No patient at Children's Hospitals and Clinics-St. Paul, MN who received even one dose of LEV IV, from August 2006 when it was first available, to February 2008, was excluded from this analysis.