Abstracts

Rationale: Levetiracetam (LEV) is currently approved as adjunctive treatment in patients with partial seizures with or without secondary generalization. It may be efficacious as monotherapy in the above group of patients. Its pharmacokinetic profile and ease of use may probably make it a well tolerated medication, especially in elderly patients with multiple comorbidities and on multiple medications. We report our experience with use of LEV as monotherapy in the VA population. Methods: Inclusion criteria were a diagnosis of partial seizures with or without secondary generalization and LEV monotherapy for at least 6 months. A pharmacy database search at Hines VA Hospital was conducted to identify patients with diagnosis of partial seizures with or without secondary generalization on LEV monotherapy. We identified 75 patients who fit the inclusion criteria. We conducted a retrospective chart review and performed a detailed analysis on those patients. Analysis of data revealed the following: age (ages 33-89 years, mean 68.8 years); gender (73males, 2 females); seizure type- complex partial (n =32), with secondary generalization (n = 42), simple partial (n = 1); age at seizure onset (median age 62 years); etiology of seizures -categorized as stroke (n=25), intracerebral hemorrhage (n=10), tumor (n=5), trauma (n=7), idiopathic epilepsy (n=26) and other (n=2); baseline seizure frequency; LEV dosing (250 mg -1500 mg bid); duration of LEV treatment (8 - 88 months, median 24 months); previous AED usage (patients began LEV as either first line therapy (n=33) or were converted to LEV from other AEDs (n=42). Data about EEG/imaging findings, comorbidities and other concomitant medications used was also collected. A subgroup analysis in the elderly patients over 60 yrs (n = 57) was also conducted. Results: 60 patients (80%) achieved seizure freedom, 10 patients (13%) showed a seizure frequency reduction of >75%, 4 patients (5.3%) showed reduction of >50% and result in 1 (1.3%) was unknown. The reported adverse events included lethargy, somnolence in 8 (10%), psychiatric symptoms in 4 (5%) and other in 3 patients (4%). LEV did not have to be discontinued due to side effects. The number of concomitant medications varied from 3-18. Review of data did not indicate any change in any of the medications secondary to perceived interaction with LEV. In patients over 60 yrs age (n=57), 48 patients (84%) achieved seizure freedom, 6 patients (10.5%) had seizure frequency reduction of > 75%, 3 (5.3%) had seizure frequency reduction of > 50%. Adverse events included lethargy /somnolence in 7 (12.8%), psychiatric symptoms in 4 (7%) and other in 1 patient (1.7%). Conclusions: Our study demonstrates that LEV is effective as monotherapy in adults with partial seizures with or without secondary generalisation. It shows that LEV was well tolerated, especially in the patients > 60 years of age with other comorbid medical conditions on multiple concomitant medications. A prospective, double blind study is necessary to confirm our findings. (Supported by UCB Inc.)