Abstracts

Reports on the use and safety of levetiracetam (LEV) in the neonatal period and early infancy are very scanty. We describe four observations on the efficacy and safety of LEV syrup in neonates and young infants with seizures refractory to conventional treatment. Patient 1: A neonate suffering from refractory seizures since day 1 has been diagnosed as malignant migrating partial seizures. LEV was well tolerated and resulted in remarkable seizure improvement (from [gt] 300 a day to [lt] 20) based on clinical and EEG observation. Unfortunately, this infant later died of possible sudden unexpected death of infants (SUDI) syndrome at the age of 14 months.
Patient 2: She suffered from bilateral, asymmetric, and numerous (up to 50 /day) partial seizures when three weeks old. MRI was considered as unremarkable and PETscan showed a left fronto-temporal hypometabolism. After an initial improvement under LEV, there was a secondary worsening during the up-titration. Doses were reduced and seizures disappeared. Her psychomotor development and her further EEG were normalized.
Our 3^rd patient with an early epileptogenic encephalopathy with generalized fits starting at four months and the 4^th patient with partial seizures from birth-day were refractory to most treatments and tried LEV with good tolerance but no benefit over other conventional antiepileptic drugs. There were remarkable clinical and EEG responses to treatment with LEV syrup in two of our patients who were resistant to conventional anti-epileptics. In these patients as in the 2 others, there was good tolerance and no adverse side-effects. .
None of our four LEV-treated patients developed intolerance to fructose which is contained in the syrup form of this medicament that we used in this study. In light of the positive therapeutic response to LEV obtained in our cases and in a few other reported cases who were refractory to conventional treatment, and, given the good tolerance, and the absence of side-effects in all the cases we treated with LEV syrup, it sounds reasonable to encourage its use in the treatment of infantile epilepsy even at very young ages including neonates when conventional antiepileptics fail. This approach would help cases refractory to other treatments, thereby, reducing the number of unresponsive cases and syndromes . Careful adjustment of dose (through gradual but slow increase in dose) is critical as higher doses might worsen the condition. In addition, further long-term safety data must be collected.