Abstracts

Rationale: Levetiracetam (LEV) is an antiepileptic drug approved in many countries for use in patients with partial-onset seizures. Although randomized, double-blind, controlled clinical trials have focused on focal epilepsies in children, adolescents and adults with and without secondary generalisation, preliminary evidence suggests LEV may also have an effect on primary generalized seizure types as well. Although several studies have reported the efficacy of LEV in juvenile myoclonic epilepsy, to the best of our knowledge no studies have been published on the efficacy of LEV in a different model of generalised epilepsy as the absence epilepsy. The aim of our study was to report on the efficacy and the tolerability of LEV in an unselected group of patients with absence seizures who attended the epilepsy services of the participating hospital in the period April 2005-April 2007.Methods: We have followed 15 patients (6F and 9M) with a mean age of 8.1 years at onset of absence. Baseline seizure frequency ranged from 3 to >60 per day. Out of 15, 8 patients received LEV as de novo therapy while 7 as add-on therapy to other drugs (e.g. valproate, lamotrigine, ethosuximide and phenobarbital). Therapeutic dose was between 1000 and 2000 mg/day. The duration of treatment with LEV ranged from 3 to 24 months (mean:7.9 months). During every follow-up visit we administered a questionnaire about side effects to evaluate tolerability to LEV. Results: At the last observation, 7 patients achieved seizure freedom, and one patient showed a seizure frequency reduction of > 75 per cent, including 4 subjects treated with LEV as monotherapy. Seizure frequency following Lev therapy remained unchanged in the remaining 7 patients, including 2 patients in add-on therapy. EEG data were evaluable in all patients: 8 patients achieved abnormality suppression, while in the remaining 7 no changes were observed. Treatment with LEV as monotherapy was discontinued in 4 children because a significant migraine was reported.Conclusions: The majority of patients with absence seizures demonstrate a good response to first-line therapy if appropriately selected. Choice of individual antiepileptic drug (AED) is determined mainly by the type of seizure, by the tolerability profile, ease of use and interaction potential of the candidate drug. Among these new generation of AED, LEV has an attractive side-effect profile, favourable pharmacokinetic characteristics, low protein binding and a prompt efficacy at starting doses. Our experience, albeit on a small sample, seems to suggest that can be effective and well tolerated in patients with absence seizures. Animal studies in genetic models and small open-label or single-blind trials in humans indicate LEV may reduce the frequency of generalized-oneset seizures, but not randomized, controlled trials have studied this. The ability of LEV to reduce these patterns of network hyperexcitability supports the potential use of this new antiepileptic drug in primary generalized epileptic disorders.