Abstracts

Levetiracetam is a second generation anticonvulsant which is currently FDA-approved for the adjunctive treatment of partial-onset seizures in adults. The failure of currently approved first-line agents to adequetly control seizures in the pediatric population prompts the frequent off-label use of levetiracetam in this population. In addition levetiracetam has pharmakokinetic advantages including renal excretion, lack of protein binding and lack of inhibition or induction of liver enzymes, which favor its use in the setting of polypharmacy.This study reviews the experience with levetiracetam in a hospital-based population. A list of all patients who recieved levetiracetam while admitted to Loyola University Medical Center in 2004 was obtained through a pharmacy database. A total of 18 pediatric patients were identified in this manner. Patient records were reviewed to determine the etiology of the underlying epilepsy, the use of levtiracetam as monotherapy or first-line therapy, the other anticonvulsants used, previous anticonvulsant use, doses of levetiracetam employed and response to therapy in terms of efficcy and tolerability. The population surveyed, children hospitalized with seizures, selected a particularly refractory group of patients. All patients who recieved levetiracetam in the hospital setting in this study suffered from severe, refractory epilepsy. No patient was on monotherapy and none recieved levetiracetam as first-line therapy.
The great majority of the patients (85%) suffered from some degree of mental retardation or developmental delay.
The typical patient who recieved levetiracetam was already taking two or three other anticonvulsants and had a history of failed attempts on multiple medications. One patient had a vagus nerve stimulator implant.
Three patients remained seizure free at initial follow-up following addition of levetiracetam to the medication regime. All of these patients were taking two anticonvulsants, taking levetiracetam in combination with lamotrigine, topiramate and zonisamide respectively.
No allergic reactions were reported and doses of other anticonvulsants did not require adjustment with addition of levetiracetam. The most commonly reported significant adverse event was personality change. Early experience of levetiracetam in a hospital based pediatric population indicates its use as an adjunctive medication in the most severly intractable cases. In contrast with the experience in adults, levetiracetam is not used as first-line therapy in this population, nor was it used as monotherapy.
Despite the refractory population studies levetiracetam had a positive impact on seizure control in a significant minority of patients. Further study of levetiracetam in children is warranted, particulary it role as adjuntive therapy in refractory epilepsy. (Supported by UCB Pharma.)