Abstracts

Rationale: Intravenous levetiracetam (IV LEV) is being used increasingly in the inpatient and emergency setting. We performed a retrospective study evaluating (1) the safety of IV LEV in routine inpatient care, and (2) the efficacy in well-documented acute seizure emergencies. Methods: Pharmacy Services provided a report of all patients who received IV LEV during an admission to one of the Mayo Rochester hospitals between 8/1/06 and 9/1/07. Of 151 patients who received IV LEV infusions during inpatient admission, 144 consented to be involved in medical research. The medical records of all 144 patients were evaluated for documented adverse events associated with IV LEV infusion. In 24 patients with well-documented acute seizure emergencies, the medical record was reviewed for adverse events, response to therapy and need for additional medications (other than IV benzodiazepines used during initial emergency therapy). "Acute seizure emergencies" was defined as the presence of convulsive status epilepticus (SE), non-convulsive SE (NCSE) verified by EEG, or >1 well-documented seizure within preceding 24 hours. Patients were not considered to have an "acute seizure emergency" as defined if seizure documentation was poor or if it was used in clearly non-acute situations. IV LEV was determined “effective” in the acute seizure emergencies if no further seizures were observed for 24 hours after administration, “indeterminate” if seizures stopped for 24 hours but another anticonvulsant was used concurrently, and “ineffective” if clinical or electrographic seizures persisted or returned within 24 hours following administration. The study was approved by the Mayo IRB. Results: Of the 144 patients treated with IV LEV, no adverse events were documented. IV LEV was infused out of the ICU without intensive respiratory, cardiac, or blood pressure monitoring in 111 patients. IV LEV was also used in 28 pediatric patients (age range 28 days - 15 yrs). No adverse events were documented in pediatric patients at dose range of 5mg/kg - 36.6 mg/kg. Of the 24 patients treated for acute seizure emergency, 11 patients were treated for >1 seizure 24 hrs, convulsive SE in 5, NCSE in 4, and EPC in 4. Of these, IV LEV response was determined to be “effective” in seven (29%), “indeterminate” in 15 (63%), and “ineffective” in two (8%). Conclusions: In this retrospective study, IV LEV was definitely effective in the acute seizure emergencies in 29%. No significant adverse events were reported in all 144 patients of pediatric and adult ages evaluated. These findings would support investigation of IV levetiracetam in a prospective fashion as an initial treatment following IV benzodiazepines in the acute seizure emergencies.