Abstracts

In the initial regulatory studies, levetiracetam (LEV) was shown to be effective as adjunctive treatment in patients with partial onset seizures. LEV has multiple mechanisms of action. Open use of LEV has suggested that it is very well tolerated and may be effective in different age groups and as monotherapy. The objective of this study was to evaluate the treatment outcome of LEV use in a epilepsy center population stratified by age of the patient.
This is a retrospective chart review of patients treated with LEV in the International Center for Epilepsy at the University of Miami. Outcome was stratified by age: 0 -19 yrs (Group 1), 20 - 39 yrs (Group 2), 40 - 59 yrs (Group 3), and 60+ yrs (Group 4). All patients were evaluated for seizure response, reason for discontinuing treatment, adverse events, dose, plasma level, and type of seizure being treated.
A total of 171 patient records were reviewed. There were 3 in Group 1, 78 in Group 2, 69 in Group 3, and 21 in Group 4. Doses used ranged from 250 mg/day to 5000 mg/day (mean = 1830 mg/day). Discontinuation rate was 0% for Group 1, 29.5% for Group 2, 26.1% for Group 3, and 33.3% for Group 4. The side effects for which patients stopped LEV therapy were increased seizures (n=6), behavioral changes (n=5), bad feeling (n=1), pedal edema (n=1), pregnancy (n=1), shakiness (n=1), sedation (n=1), and increased salivation (n=1). There was no difference in incidence of side effects between age groups. Seizure freedom was achieved in 29.2% of patients with primary generalized epilepsy while only 6.9% of patients with partial epilepsy were seizure free. Seizure free rate by stratified by age was 0% (Group 1), 10.3% (Group 2), 17.4% (Group 3), and 19.0% (Group 4). A greater than 75% reduction of seizures was observed in 33.3% in Group 1, 6.4% in Group 2, 15.9% in Group 3, and 19.0% in Group 4. Group 4 had a 47.5% incidence of 50% or greater reduction in seizures; higher than any other age group. Of the 24 patients on LEV monotherapy, 8 were seizure free.
The results of this study suggest that levetiracetam is very effective and well-tolerated across all age groups in both partial onset and primary generalized epilepsies. In the patient population, LEV was tolerated well and found to be most effective in the oldest age group analyzed (60 yrs and older). The findings also support that LEV is effective as monotherapy and in the treatment of primary generalized epilepsy.
[Supported by: UCB Pharma]