Abstracts

Rationale: Clinical seizures in patients with ESES as well as ESES patterns on EEG are notoriously difficult to treat and often do not respond to a variety of drugs and other treatment options including benzodiazepines, valproate, ethosuximide, carbamazepine, phenytoin, IVIG, ketogenic diet and surgery. Optimal treatment is still undetermined. We report 3 patients with ESES treated with IV Levetiracetam. Methods: Retrospective chart review was performed on patients seen at Children Hospital of Pittsburgh from 06/2007 to 05/2009 with ESES syndrome treated with IV Levetiracetam. Data regarding demographics, seizure type, epilepsy syndrome, EEG findings, previous antiepileptic medications used were collected and analyzed. Results: Three male patients, ages 3, 10 and 11 years with complex partial seizures and secondary generalization and EEG findings consistent with ESES syndrome were started on levetiracetam as the 2nd line of treatment after either benzodiazepines or phenytoin failed to make any improvement on concurrent EEG pattern. Intravenous administration of levetiracetam 20mg/kg was followed by oral maintenance doses (range 20 - 110 mg/kg/day divided in 2 doses). All 3 patients had VIDEO EEG monitoring on the initiation of treatment and in 1-3 month follow up that showed complete resolution of ESES pattern and normal or near normal EEGs. Clinical seizures also resolved in all 3 patients. Only one patient had relapse of the ESES pattern on EEG after several months with no clinical seizures. Patients with normal EEGs were successfully weaned off several other medications that were being used concomitantly for seizure control. Conclusions: Levetiracetam was effective in treating the ESES pattern on EEG as well as clinical seizures associated with this syndrome. We are reporting this data to promote awareness of a known antiepileptic medication with a relatively benign side effect profile available in intravenous form that is potentially effective in treating this difficult to control epilepsy syndrome. More long term follow up data are needed to fully evaluate the effectiveness of this new therapy.