Abstracts

RATIONALE: Levetiracetam has been approved as adjunctive treatment for adults with partial onset seizures. We wished to evaluate our experience with levetiracetam as monotherapy. At the end of this analysis, we expect LEV can be used effectively as monotherapy in adults with new onset seizures and difficult to control epilepsy.
METHODS: We retrospectively reviewed the charts of all of our patients with a confirmed diagnosis of epilepsy who tried LEV monotherapy. Patients began LEV either as first line therapy or were converted to LEV monotherapy after failing their prior antiepileptic medications (AEDs).
We reviewed demographic data, diagnostic evaluation for epilepsy, seizure types, and seizure frequency prior to and following initiation of LEV monotherapy. Adverse events (AE) while on LEV were noted.
RESULTS: We identified 28 patients, ages 18-78, (mean 39.5) with history of partial seizures with and without secondarily generalization. The duration of epilepsy ranged from 1-30 years, (mean 10 years). Eight of these patients began LEV as first line therapy, three of which had liver disease. Twenty patients were converted to LEV monotherapy after they failed their initial trials of AEDs, which included Dilantin, Tegretol, Depakote, Lamictal, and Topamax, (mean 2.3).
Of the 28 patients, 25 (89%) of the patients continued on LEV monotherapy for at least 6 months. Nine of the 25 (36%) were seizure free. Three patients who began LEV monotherapy were seizure free, whereas the remaining 6 patients who began LEV as add-on therapy and converted to monotherapy became seizure free.
Of the remaining patients 7/25 (28%) had more than 50 % seizure reduction and 7/25 patients had [gt] 75% reduction of seizures. The remaining 2 patients had no significant change in seizure frequency. The total dosages used to control seizures were 1000-4000 mg/day (mean 2053 mg/day).
Four of 28 patients (14 %) reported agitation at the start of treatment, of whom 3 discontinued therapy in 2 weeks at dosages less than 500/ day. No other AEs were reported.
CONCLUSIONS: LEV monotherapy can be effective and well tolerated in adults with new onset and difficult to control epilepsy. A prospective, large, double-blind study is needed to confirm this finding.