Abstracts

Rationale: Our study aims at examining the efficacy and side effects of intravenous (IV) levetiracetam (LEV) in pediatric patients diagnosed with epilepsy and hospitalized with complaints of acute repetitive seizures(ARS) and at determining the factors affecting treatment response. Methods: All cases between the ages of 0-18 diagnosed with epilepsy and given IV LEV following hospitalization with complaints of ARS between 2010 and 2013 were retrospectively examined. The cases were examined in terms of age, sex, age at first seizure, seizure type, etiology, interictal EEG findings, neurological abnormalities, existence of epileptic syndrome, IV antiepileptic medication given before LEV, peroral (PO) antiepileptic medication taken, loading and maintenance doses, side effects and short and long term treatment response. Two groups of patients with positive (Group 1) and negative (Group 2) response to short term IV treatment were compared. Results: Of the 133 patients, 73 (%55) were males, 60 (%45) females whose median age was found as 41,3 months (IQR 104,8) and the age at first seizure as 11 months (IQR 42,45). It was found that 76 (%57,1) of them had symptomatic, 35 (%26,3) idiopathic, 22 (%16,5) cryptogenic epilepsy .104 of the patients (%78,2) were found to have responded positively to treatment. Of these 104 patients, 89 (%85) responded positively to long term PO treatment and 63 of them (%70) had no seizures and in 26 (%30) a %50 decrease was observed in the number of seizures compared to the past. The follow-up period of the patients was 7 months (IQR 21). The age of Group 2 at application and at first seizure was less than the age of Group 1 (p=0,002, p=0,001). It was found that patients with pathologic interictal EEG, neurological abnormality and epileptic syndrome were predominant in Group 2 (p=0,04, p<0,001, p<0,001). In the logistic regression analysis, a predictivity model was obtained consisting of the variables of the age at first seizure, neurological abnormality and epileptic syndrome. It was found, according to this model, that the risk of short term IV treatment response to be negative increased 4 times (OR:4,02, %95CI:1,4-11, p=0,007) in patients whose seizures initiated at young ages, 6 times (OR:6,1, %95CI: 1,9-19, p=0,002) in patients with neurological abnormalities and 22 times (OR:22,2, %95CI: 2,5-198, p=0,005) in those with epileptic syndrome. In the ROC curve analysis, cut-off value was determined to be 13,5 months (AUC:0,688, %95CI:0,56-0,81, p=0,002) for age and 3 months (AUC: 0,698, %95 CI: 0,58-0,8, p=0,001) for seizure initiation age. Conclusions: In our study, IV levetiracetam was found quite effective and safe in the short and long term control of ARS in children diagnosed with epilepsy. It was found that the patients whose treatment failed to be effective were at young ages at their first seizure and had neurological abnormalities and epileptic syndrome; and these findings are considered to be useful for predicting the risk of negative response to treatment.