Abstracts

Levetiracetam(LEV) is an antiepileptic drug(AED) approved for adjunctive therapy of partial onset seizures in adults and children over 16 years of age. Current prescribing information recommends gradual titration at a rate of advancing 1000mg every two weeks in adults (target dose 3000mg/day) and by 20mg/kg every two weeks in children (target dose 60mg/kg/day). LEV is well tolerated, effective AED with wide margin of safety. There are some reports of rapid titration in adults (1), reaching therapeutic dose in 3 days and inconsistent data on medium quick titration in children, advancing every 4 days (2, 3). The purpose of this analysis is to examine efficacy and safety of rapid titration in the certain circumstances that require rapid control of seizures due to ineffectiveness or unacceptable side effects of other AEDs. We report 8 pediatric patients who had an improvement or full control of seizures with the rapid titration. Retrospective chart review was performed on patients seen at Children[rsquo]s Hospital of Pittsburgh with childhood epilepsy treated with Levetiracetam that was titrated to full dose in 2 weeks or less. Data regarding demographics, seizure type, epilepsy syndrome, MRI and EEG findings, treatment duration, AED[rsquo]s use were collected and analyzed. 8 children (7 females and 1 male) ages 19months -17 years (mean age 8.6) with complex partial seizures (75%), mixed seizures (12.5%), generalized seizures (12.5%) were started on Levetiracetam and titrated up over 2 to 14 days (mean 10 days). All had improvement in seizure activity and 6(75%) became seizure free, including 1 patient with hemimegalencephaly who presented in non-convulsive status epilepticus, was treated with 40 mg/kg on day 1, 60 mg/kg on day 2, became stable, and proceeded to functional hemispherectomy, 2 patients with carbamazepine induced and idiopathic neutropenia, respectively, 2 patients with low grade tumor, 1 patient with autism. 1 patient(12.5%) required weaning of Levetiracetam because of behavioral problems observed 5 weeks latter at dose of 60 mg/kg/day. 62.5% were on LEV monotherapy. Rapid titration of Levetiracetam has shown to be an effective in childhood epilepsies with partial or generalized seizures under curtain circumstances. No increase in side effects had been observed in our series. More data are needed to evaluate this hypothesis. That could broaden physician[rsquo]s choices of AEDs for use when rapid initiation of therapy is required.

1.Bryant AE, Rapid titration of Levetiracetam is effective and well tolerated. Poster. Epilepsia 2002;43:217.
2.Nakken KO, at al, A paradoxical effect of levetiracetam may be seen in both children and adults with refractory epilepsy. Seizure 2003;12:42-6.
3.Lagae L, at all, Effect of levetiracetam in refractory childhood epilepsy syndromes. Eur J Pediatr Neurol 2003;7:123-8.