Abstracts

RATIONALE: Levetiracetam is a recently FDA approved antiepileptic drug for use in people over 16 years of age with complex partial seizures. Its mechanism of action is different from other anticonvulsants. There has been little written, however, of its use in pediatrics and no reports correlating levetiracetam levels with efficacy and side effects. This study was done to evaluate these aspects.
METHODS: Charts were reviewed and some parents interviewed for all the patients started on levetiracetam from May, 2000 and followed through April, 2002 for treatment of epilepsy and/or migraine headaches. Data collected included relevant demographic and clinical information. The age range was 5 years of age to 19 years.
RESULTS: Of the 24 patients with intractable seizures, 9 of these achieved 100% seizure control on Levetiracetam; 8 achieved 75 [ndash] 99% improved control; 5 achieved 50 [ndash] 75% improved control; 1 achieved 39% improved control and 1 had no improvement. Of the four children with Lennox-Gastaut epilepsy, 1 female had 100% control of her epilepsy, 1 male had 92% improved control of his seizures, 1 had 50% improvement and 1 had no change. The reduction of seizure frequency in the autoimmune group was as follows: For the female with continuous spike and slow wave of slow sleep it was 93%. The Landau-Kleffner syndrome female had a 50% decrease. The two males with Rasmussen[ssquote]s encephalitis had 85% and 39% decrease in seizure frequency.
Levetiracetam levels associated with successful treatments of intractable epilepsy were as follows: Lennox-Gastaut = 7.8 [ndash] 33 ug/ml trough to peak range for greater than 50% seizure control, using doses of 12.7[ndash]67 mg/kg. The intractible epilepsy group had levels of 6.4-60 ug/mg trough to peak with doses of 41.38-84 mg/kg/d. Of the six patients with absence seizure disorder, three had 100% control with adding Keppra. Levels correlating with good control of absence seizures and ranged from 16-21 ug/ml on 23-37.5 mg/kg/d. There were eight patients with complex partial seizure disorders and migraine headache problems. Seven out of eight patients in this group responded 100% to seizure control with Keppra. The levels associated with success trough to peak ranged from 20-39 ug/ml. Doses ranged from 23.7-72.2 mg/kg. Bad behavior in the autistic or cerebral palsy patient correlated with doses of 47.5-68 mg/kg. Calmer behavior was at 13-15.8 mg/kg with levels of 4.2-8.9 ug/ml trough to peak. Nine of the 36 patients had significant cognitive improvement.
CONCLUSIONS: About one-third of the intractable epilepsies had full control with adding Levetiracetam. All the complex partial seizure disorder patients with a comorbid migraine headache component benefited significantly. The absence seizure disorder patients who had failed on other medications responded well with complete control three out of six. The adverse behavioral side effects of Levetiracetam are seen more often in patients with mental retardation and correlate with levels greater the 16mg/ml. Cognition was improved in one-fourth of the patients and worsened in none. Further larger studies will elucidate the usefulness, optimum levels and potential side effects in children.
[Supported by: Unrestricted Educational Grant]; (Disclosure: Grant - Unrestricted Educational Grant, UCB Pharma)