Abstracts

Antiepileptic drug (AED) monotherapy is increasingly preferred to combination therapy as seizure control can be achieved with fewer risks of adverse effects and drug interactions. Levetiracetam, well established as add-on therapy for refractory partial seizures, has been shown to be effective as monotherapy for up to 12 weeks in patients responding to it use initially as add-on therapy (Ben-Menachem et al. [italic]Epilepsia [/italic]2000;41:1276-83).This study aimed to review the long-term efficacy of levetiracetam in patients with refractory epilepsy successfully converted from levetiracetam add-on therapy to monotherapy following the withdrawal of baseline AEDs. This is a retrospective (and still ongoing) analysis of our epilepsy clinic patient database. Data were reviewed from 352 patients who had received levetiracetam initially as add-on therapy. Our study population consisted of those patients who successfully converted to levetiracetam monotherapy and remain on monotherapy. In our clinic of 538 patients with chronic intractable epilepsy, 352 have been commenced on levetiracetam over a 3 year period. Of these, 52 are currently receiving levetiracetam monotherapy, having withdrawn from all other AEDs. Of these 52 patients, 24 (46%) have been entirely seizure-free for over 12 months and a further 8 (15%) seizure-free for 6 to 12 months. Of the 52 patients, 19 (36.5%), 21 (40.4%) and 12 (23%) were withdrawn from 3, 2 and one other AED(s) respectively.
Of the 20 patients still having seizures on levetiracetam monotherapy, all report reduced seizure frequency of more than 75% and 13 report reduced seizure severity.
This paper will also present three typical case histories of patients receiving levetiracetam monotherapy. Levetiracetam, on the basis of this open series, appears to be effective and safe when used as monotherapy for epilepsy. (Supported by Research Grant from UCB)