Abstracts

Objective: To examine the efficacy and tolerability of levetiracetam as monotherapy in elderly patients.
Background: Elderly patients may have increased sensitivity to the effects of antiepileptic drugs (AEDs), due to age-dependent changes in pharmacokinetics and pharmacodynamics. These may include a lower degree of drug binding to plasma proteins and decreased metabolic and renal drug clearance.
Levetiracetam (LEV) has been approved as adjunctive treatment for adults with partial onset seizures. LEV has a favorable pharmacokinetic profile that includes minimal protein binding, lack of hepatic metabolism, and twice a day dosing. These features and others make it ideal for use as monotherapy in elderly patients.
We retrospectively reviewed the charts of all of our elderly patients with a confirmed diagnosis of epilepsy. Thirty-three patients were identified. Of these, fifteen patients began LEV either as first line therapy or were converted to LEV monotherapy after failing prior AEDs.
We reviewed demographic data, diagnostic evaluation for epilepsy, seizure types, and seizure frequency prior to and following initiation of LEV monotherapy. We compared baseline seizure counts from the two months prior to initiation of LEV treatment to seizure counts at six months of followup after LEV was started and maintained as therapy. Adverse effects while on LEV were noted.
We identified fifteen patients, age 62-92 years, (mean 66 years) with a history of partial seizures with and without secondary generalization. The duration of epilepsy ranged from 1-39 years (mean 12.6 years, median 2.5). Five of these patients began LEV as first line therapy. Two of these patients had liver disease and wished to avoid AEDs that required hepatic metabolism. The remaining three patients chose to start LEV for its favorable pharmacokinetic and side effect profile. Ten patients converted to LEV monotherapy after they failed their initial trials of AEDs, which included Dilantin, Tegretol, Depakote, and Lamictal.
Six patients had an identifiable cause to their seizures: Three secondary to head trauma, two from strokes, and one due to Alzheimer[apos]s disease.
Of the fifteen patients, fourteen of the patients continued on LEV monotherapy for at least six months. One patient was lost to followup. Eight patients (57%) became seizure free. Four patients who began LEV as monotherapy became seizure free; the remaining four patients who began LEV as add-on therapy became seizure free.
Three patients (21%) had more than a 50% seizure reduction and three patients (21%) had more than 75% reduction of seizures. Total dosages used to control seizures were 500-3000 mg/day (mean 1839.2 mg/day).
One patient reported being dizzy within days after starting LEV, but was able to continue on LEV. No other major side effects were reported.
LEV monotherapy can be effective and well tolerated in elderly patients with epilepsy. A prospective, large, double-blind study is needed to confirm this.