Abstracts

To evaluate the clinical efficacy and safety of levetiracetam as initial monotherapy for children with a diagnosis of new onset epilepsy., A retrospective review of medical records was performed to identify children up to 18 years who were given a new diagnosis of epilepsy and were treated with levetiracetam as initial maintenance therapy. Treatment was initiated between January 1, 2003 and October 1, 2005. All patients were initially evaluated by a pediatric neurologist at Arkansas Children[apos]s Hospital. Outcome was determined by review of the last clinic follow-up and/ or by telephone interview. The primary outcome measure was the achievement of seizure freedom for a minimum period of 6 months. Questions were asked concerning adverse effects during treatment with levetiracetam. Treatment was started following a single or prolonged seizure with electroencephalogram (EEG) findings supportive of a diagnosis of epilepsy, or following recurrent seizures with a supportive or normal EEG. Patients could have been treated with medications emergently for seizures prior to starting levetiracetam. Patients who had been treated previously with a maintenance antiepileptic drug were not included. Parents or caregivers were specifically asked if they had noted changes in behavior or other adverse events., 82 children between the ages of 10 months and 17 years of age (mean 6.0 years) were identified who were treated initially with levetiracetam monotherapy for epilepsy. There were 46 males and 36 females. Seizure freedom was achieved for a period of at least 6 months in 70 patients (85.4%). Twelve patients were considered treatment failures due to peristent seizures in eight, or discontinuation of medication due to adverse effects in four (worsened behavior in 2, ataxia in 1, and rash in 1). The total dose ranged from 200 to 3000 mg per day and was divided bid. In the group with controlled seizures for a minimum of 6 months, the dose ranged from 10-36.9 mg/kg/day (mean 21.3 mg/kg/day). In the failure group, the dose ranged from 10.5-51.4 mg/kg/day (mean 25.0 mg/kg/day). There were no serious adverse events. Mild adverse events were reported in 24 patients (29.3%). Deterioration in behavior or mood was reported in 16 patients (19.5%). Behavioral problems resolved in 2 of 3 patients treated with pyridoxine, and in an additional 5 simply over time. Improved behavior was reported in one patient. Additional adverse events included sleepiness (1), dizziness (1), ataxia (1) and rash (1)., Levetiracetam appears to be very effective and safe as initial monotherapy for children with epilepsy. Adverse effects are generally mild . Behavioral side effects were reported in almost 20% of patients, but only 2 patients discontinued the medication due to behavioral issues. Prospective evaluation of levetiracetam as monotherapy in children is warranted.,