Abstracts

In population studies, stroke is the most commonly identified cause of epilepsy in adult populations older than 35 years.The incidence of post stroke seizure is 5.7% (3.5-7.9) at 1 year and 11.5% (4.8-18.2) at 5 years.
Treatment of epilepsy with available AEDs is often a compromise between efficacy, safety and tolerability, and ease of use. Levetiracetam (LEV) represents an advance in the treatment of seizures. LEV has unique and favorable pharmacokinetic profile that includes rapid and complete oral absorption, minimal protein binding, no hepatic metabolism, renal clearance and a half-life of 6-8 hours. These properties made us use LEV in post stroke seizure patients. We report our experience on the safety and efficacy of LEV in post stroke seizure patients. We retrospectively studied the post stroke seizure patients that received LEV from 2001 to 2003.
We were able to retrieve 45 post stroke seizure patients on LEV for 2 years. We reviewed the demographic data, number of seizures, primary diagnosis, date of hospitalization, reason for admission, starting and final dose of LEV.
The diagnostic studies CT/MRI, laboratory values of renal, hepatic, hemotological dysfunctions were charted. Any side effects, other AEDs and other medications were recorded. Particular attention was paid to any drug interactions and any side effects that lowered or increased dose of LEV. Starting dose was 500mg bid (range 250 to 2000mg). Oral loading of 1500 to 3000mg was done in 3 patients with recurrent seizures, 2 with status epilepticus (as add-on to iv fosphenytoin). The patients were followed up for 2 years. Age range of patients on LEV was 41 to 90 years, these were 19 men, 26 women. 24 had ischemic stroke and 21 had hemorrhagic stroke (ICH 11, Subdural hematoma 3, SAH 3, hemorrhagic conversion 4). 24 patients came to the hospital due to first seizure.
LEV was used as monotherapy in 24 patients and as add-on therapy in 21 patients.
20/24 (83%) patients on monotherapy and 18/21 (86%) on add-on therapy were completely seizure free. 2 patients experienced recurrent seizures on LEV. Their dosage was increased from 250mg to 750mg and from 500mg to 1500mg. 1 other patient had LEV withdrawal seizures.
Sedation was reported by 6 (13%) patients, dizziness by 2 (4.5%), psychiatric changes by 2 (4.5%). Only 2 (4.5%) discontinued due to side effects. Among the other AEDs phenytoin was given to 10 patients, iv fosphenytoin 8, sodium valproate 2, phenobarbital 1 and trileptal 2.
No interactions of LEV with other medications ie warfarin, aspirin, plavix, tPA, digoxin, antihypertensives, statins were noted. In particular no change in INR or Prothrombin time was noticed. Levetiracetam is an effective AED in post stroke seizures as mono and add-on therapy. Its low adverse-effect profile, lack of protein binding and no hepatic clearance makes it a drug of choice. In patients with stroke/multiple medical problems on multiple medications , it should be considered as first-line AED.