Abstracts

Status epilepticus (SE) is a common neurological emergency, with a mortality of approximately 20% in adults. Treatment strategies have changed little over the last two decades. There is thus a need for alternative pharmacological therapies. Levetiracetam (LEV) has wide spectrum of action and a favorable pharmacokinetic profile, especially for subjects receiving other co-medications. However, little data exist regarding its use in SE. We identified patients with SE who received LEV, among other treatments, in a database of two tertiary referral hospitals comprising 127 SE episodes. Patients younger than 16 or with a hypoxic-ischemic etiology were excluded. Demographic, clinical and pharmacological data were analyzed, and compared to a control group consisting of 2 subjects from the database for each LEV patient, matched for age and sex. Outcome was classified as poor (death or continued SE at discharge) or good (cessation of SE and discharge from the hospital). We identified 13 SE episodes occurring in 12 patients, and matched 26 control episodes (25 patients). Demographic, etiologic and clinical characteristics did not differ statistically between the groups, and outcome was similar (2 poor outcomes in the LEV, 3 in the control group). Daily LEV dose ranged between 1000 and 6000 mg. Four subjects received LEV de novo. Two of them died (15% of total): one had refractory SE and one responded to LEV but died of medical causes 6 days later. Among the other 9 episodes, LEV dosage during SE was increased in 5 and unchanged in 4; the outcome was good in all. Change in LEV dosage was temporally linked to SE control in 3 subjects, although in each another medication was escalated at the same time, whereas 1 did not respond, and 1 received LEV immediately after SE treatment. For the 4 patients receiving LEV prior to onset of SE and in whom dose remained constant, no statement can be made regarding treatment responsiveness. In summary, 3 patients were probable responders (23%), 1 responded to the treatment but subsequently died (8%), 4 were non-responders (31%, 1 died), and 5 had an undetermined response (38%). Blood levels were not checked sufficiently often to determine whether variations in absorption or elimination played a role in outcome. LEV was used in more than 10% of the database patients. Whereas LEV possibly contributed to SE control in 3 patients, 4 others developed refractory SE. Statistical analysis showed no difference in the efficacy of SE treatment between subjects treated with and without LEV. This is not surprising, since in its oral form LEV was used as an additional ^2nd line drug, and in SE the timing of administration determines the effect of the drug (Treiman 1999). LEV may represent a useful alternative in the treatment of SE, particularly if a parenteral form becomes available, in order to allow an earlier administration. To better define its role in this setting, prospective studies are needed. (Supported by UCB Pharma.)