Abstracts

Rationale: Children with epilepsy have frequent hospital admissions because acute repetitive seizures and may require multiple agents for adequate seizure control, while children with new-onset seizures as well as neonatal seizures also require acute and long-term management. Intravenous (IV) levetiracetam became available in August 2006 in patients aged 16 years and above. There is not enough data about acute and long-term efficacy and tolerability of Intravenous Levetiracetam as monotherapy in children. We retrospectively analyzed data at our institution of children who received levetiracetam monotherapy for acute and long-term seizure management. Methods: A retrospective chart review was conducted on all neonates and children less than 18 years of age with established epilepsy on levetiracetam monotherapy, new-onset seizures or neonatal seizures who were treated with levetiracetam monotherapy at Scott and White Hospital/Texas A & M HSC College of Medicine, Temple, TX. Subject data were acquired from electronic medical records. Approval of this retrospective analysis was given by our hospital's Institutional Review Board. Results: We retrospectively analyzed 117 patients who met our inclusion criteria for neonatal seizures, new onset seizures or established epilepsy with breakthrough seizures who were treated and managed with levetiracetam monotherapy. There were 67 (57%) males and 50 (43%) females.51 (44%) had established epilepsy, 31 (26%) had new-onset seizures, and 35 (30%) had neonatal seizures.35 (30%) were neonates, 40 (34%) were 0-2 y/o (but older than 3 wks.), 27 (23%) were 2-8 y/o, 15 (13%) were 9-18 y/o. The loading dose of IV levetiracetam was 50 mg/kg in most patients. The dose was infused over 15 minutes to an hour. The primary objective was to assess response based on clinical and electrographic documentation at 24, 48 and 72 hours. The secondary objective was to assess adverse events and seizure control at well-child visits. Response to levetiracetam was favorable. 95 (81%) out of 117 patients reached seizure freedom within 24 hours, 79 (68%) within 48 hours and 69 (59%. Seizures continued after 72 hours in 6  patients requiring additional anticonvulsants. At 1 month follow-up, 64 (55%) remained seizure-free, 7 had fewer than previously, 14 had continued or breakthrough seizures, 14 were weaned off or additional agents added. 18 were lost to follow-up.At 6 month follow-up, 30 continued levetiracetam monotherapy and had no seizures, 12 continued and had significantly decreased/very few/minor seizures. 37 stopped levetiracetam monotherapy, mostly due to being weaned off without incident. 14 remained on levetiracetam but were not well-controlled long-term. Others lost to follow-up. No serious side-effects were apparent. No serious adverse events were reported with any of the patients, 22 patients (19%) reported behavioral changes (irritability) while on levetiracetam.  Conclusions: Levetiracetam monotherapy seems to be efficacious in acute and long-term seizure management in children with established epilepsy, new-onset seizures, and neonatal seizures. Funding: None