Abstracts

RATIONALE: There is some evidence to support the use of Keppra [reg] (levetricetam, LEV) in pediatric patients, even less evidence regarding LEV use in partial seizures associated with visual triggers. LEV offers potential benefits for pediatric patients which include simple pharmacokinetics, lack of liver metabolism and lack of drug interaction. The objective of our review was to determine the outcome of adding LEV to the regimen of 9 refractory pediatric patients.
METHODS: A retrospective chart review of pediatric patients ages 12-16 years old placed on Keppra [reg] for the control of refractory partial seizures was done. Nine of the pediatric patients were placed on Keppra [reg] in addition to their (1-3+) other anticonvulsants. All patients were queried during routine appointments about the presence of seizure triggers. These reports were compared to find common factors which might indicate which patients might respond to Keppra[reg] as an add on therapy for their partial seizures. Only patients who were verbal and able to report possible triggers were included in this analysis. MRI and EEGs were also reviewed to see if a pattern emerged based on these tests.
RESULTS: Of the 9 pediatric patient who received Keppra[reg] , 7 reported specific stimuli which seemed to be involved in making them [dsquote]feel sick[dsquote]. Sunlight, flickering fluorescent lights, arcade and mirror globe lights were the most common triggers reported in 7 of these patients. One child had his epileptic syncopal episodes on the play ground only on sunny days. Three reported problems while riding in the car. Night time oncoming car headlights were especially remarked about. Finally, a migraine quality headache was seen in all of these patients suggesting occipital lobe involvement in their seizures. None of these of these children showed an epileptic response to photic activation during the EEG.
Three patients had what appeared to be a generalized seizure pattern on EEG. Six patients showed normal MRIs. Four patients had a normal EEG. No real pattern seemed to emerge using either EEG or MRI data.
CONCLUSIONS: Keppra[reg] was shown during Phase II trials to be effective in patients who had photoparoxysmal EEG responses. Our chart review shows that true EEG positive phototparoxysmal response did not predict which children responded to this medication. Instead, clinical verbal reports suggesting activation of early seizure symptoms with visual stimuli such as sunlight, the window of a moving vehicle, problems looking at the headlights of on coming traffic at night, fluorescent and arcade lights and flashing globes activated seizures in this group of patients. Additionally reports of migraine headache, known to involve the occipital lobe, should be included as an indicator of potential positive response to Keppra[reg].
At the end of this activity readers should be able to discuss which pediatric partial seizure patients might improve with the addition of Keppra[reg] to their seizure medication regime. Keppra[reg] in currently approved for use in patients 16 years of age or older.
[Supported by: This abstract was supported in part by UCB pharmaceuticals.]; (Disclosure: Grant - Multiple UCB pediatric drug studies, Consulting - Consultant to UCB)