Abstracts

Rationale: The aim of this study was to evaluate efficacy and tolerability of levetiracetam (LEV) in patients with post-traumatic epilepsy (PTE). Methods: Twelve patients with PTE entered the study. All of them were males, with age range 26-70 years. At study enter 9 patients were already treated with antiepileptic drugs (AEDs): 4 of them still presented seizures, while the remaining 5 were seizure free. All these 9 patients complained of adverse effects related to AED treatment. In the remaining 3 patients, seizures were not treated at study entry: 2 of them had received AEDs in the past, but had discontinued treatment because of adverse effects, while the last one had never been treated with AEDs. LEV was initially given as add on therapy in all 9 treated patients: concomitant AED treatment was slowly reduced and, if possible, completely withdrawn, according to the clinical situation. The 3 untreated patients received LEV in monotherapy since the beginning. Follow up with LEV monotherapy was at least 12 months in all patients. Results: The 3 untreated patients receiving LEV monotherapy reached complete control of seizures, without adverse effects. In the 5 treated patients who were already seizure free, concomitant AED treatment was slowly reduced and eventually withdrawn: switch to LEV monotherapy was accompanied by persisting complete control of seizures. As to the 4 treated patients with uncontrolled seizures, 1 of them reached seizure freedom with LEV add on and was successively switched to LEV monotherapy; the remaining 3 showed seizure reduction > 50% with LEV add on and dosage reduction of coexisting AED treatment. None of these 9 treated patients showed new adverse effects related to LEV, and in all of them pre-existing adverse effects disappeared or showed considerable reduction with relevant improvement of quality of life. Conclusions: PTE is a chronic seizure disorder due to injury to the brain following trauma. Besides to seizures, patients with PTE may also present neurological and cognitive problems, and psychiatric disturbances such as post traumatic stress disorder. All these conditions can affect functional and social outcome, and may be worsened by the use of AEDs, which often have cognitive impairment and behavioural disturbances as possible adverse effects. In our small series LEV was effective in treating post-traumatic seizures, showing also a good tolerability without adverse effects on memory, behaviour and cognitive state.