Abstracts

Temporal Lobe Epilepsy is the most common type of epilepsy. Unfortunately there is a paucity of data showing the efficacy of antiepileptic drugs in this specific type of epilepsy. It is estimated that 60% of partial seizures arise in the temporal lobe. The efficacy of Levetiracetam in treating Temporal Lobe Epilepsy Surgery failures was demonstrated by Motamedi et al ¹.
This study was undertaken to determine the efficacy of Levetiracetam in the treatment of Temporal Lobe Epilepsy. This is a retrospective study looking at our database of over 1000 epilepsy patients. The patients were classified as having Temporal Lobe Epilepsy based on the following criteria:
A. Video-EEG confirmation of Temporal Lobe Epilepsy by ictal and interictal recordings and no other contradictory data.
Or
B. Two or more of the following criteria [ndash]
1. symptoms consistent with Temporal Lobe Epilepsy
2. Electroencephalogram showing epileptiform discharges consistent with Temporal Lobe Epilepsy
3. MRI showing mesial temporal sclerosis or a temporal lobe lesion
And no contradictory data
Thirty-one patients fulfilled the above criteria and were started on Levetiracetam. The patients were followed for an average of 16 months from the time of starting Levetiracetam. No other antiepileptic drug changes were made during this period in these patients.
The outcome was classified as:
[underline]Class 1:[/underline] Seizure free
[underline]Class 2:[/underline] [gt] 90% reduction in seizure frequency
[underline]Class 3:[/underline] [gt] 50% reduction in seizure frequency
[underline]Class 4:[/underline] [lt] 50% reduction in seizure frequency
Patients in Class 4 were designated as treatment failures. Twenty-five of the 31 patients (80.6%) with Temporal Lobe Epilepsy had a greater than 50% reduction in seizures. Sixteen of the 31 (51.6%) patients became seizure free. The average number of antiepileptic drugs these patients had failed is 3.13 before starting Levetiracetam.

[underline]Class [/underline][underline]1:[/underline] 16 patients (51.6%)
[underline]Class 2:[/underline] 4 patients
[underline]Class 3:[/underline] 5 patients
[underline]Class 4:[/underline] 6 patients
One patient had a worsening of his seizures on Levetiracetam. Greater than 50% of patients with Temporal Lobe Epilepsy, who had failed an average of more than 3 antiepileptic medications, became seizure free on treatment with Levetiracetam. The responder rate was more than 80%.
The responder rate for Levetiracetam in all partial seizure is 39.8% to 44%². This study clearly demonstrates a unique efficacy profile of Levetiracetam in Temporal Lobe Epilepsy. Large randomized controlled studies are needed to study this important efficacy profile.

1. Motamedi M, Nguyen DK, Zaatreh M, , Westerveld M, Thompson JL, Mattson R, Blumenfeld H, Novotny E and Spencer SS. Levetiracetam efficacy in refractory partial-onset seizures, especially after failed epilepsy surgery. [italic]Epilepsia[/italic]; 2003; 44(2):211-214.
2. Cereghino JJ, Biton V, Abou-Khalil B, Dreifuss F, Gauer LJ and Leppik I. Levetiracetam for partial seizures: results of a double-blind, randomized clinical trial. [italic]Neurology[/italic] 2000; 55(2):236-242.