Abstracts

RATIONALE: Levetiracetam (LEV) reduces the frequency of seizures and interictal spike-wave complexes (SWC) in patients with partial epilepsy. Although LEV has been shown to inhibit photomyoclonic responses in patients with generalized epilepsy, its effect on interictal generalized SWC is unkown. This study reports the effect of LEV on interictal SWC in four patients with idiopathic generalized epilepsy. At the end of this activity, the participants should be able to discuss the short-term effect of LEV on SWC in patients with generalized epilepsy.
METHODS: Four patients with medically intractable epilepsy were admitted to Washington University[ssquote]s Adult Epilepsy Monitoring Unit for seizure characterization and were found to have idiopathic generalized epilepsy by ictal and interictal recordings. None of the patients had abnormalities on brain MRI. Each of these patients underwent video/EEG monitoring before and after LEV administration. The incidence and duration of the SWC, controlled for sleep stage, were analyzed qualitatively for patient 1 and quanitatively for patients 2-4. Serum levels of levetiracetam were measured for patients 2-4.
RESULTS: Patient one had frequent SWC before LEV and zero SWC after LEV. Patient two had 85 SWC per hour before LEV and zero SWC per hour 24 hours after receiving two doses of 1500 mg LEV. Upon hospital admission, while on LEV (1000 mg bid), patient three had zero SWC per hour. After withdrawing LEV for seizure monitoring, patient three averaged 27 (range 6-90) SWC per hour for the 24 hours before LEV administration. From two hours after LEV (1500 mg) administration to the end of the recording (15 hours later) patient three had 0 SWC per hour. In the absence of LEV, patient 4 averaged 10 SWC per while awake and 35 SWC per hour in stage II sleep. From two hours after receiving LEV (2000 mg) through the remainder of the recording (18 hours later), patient 4 averaged 0.25 SWC per hour in wakefulness (97% reduction, p=0.01) and 12 SWC per hour in sleep (64% reduction, p[lt]0.001).
CONCLUSIONS: In the short term (within 24 hours) after receiving levitiracetam, 1.) LEV decreased the frequency of SWC in four patients with idiopathic generalized epilepsy 2.) The efficacy of LEV was dependent on sleep stage in patient 4.
[Supported by: The submitting author is supproted by an epilepsy fellowship training grant.]; (Disclosure: Grant - F. Gilliam has a clinical research grant funded by UCB Pharma, Consulting - A. J. Fessler has served on the advisory board for UCB Pharma, Honoraria - H. Attarian and F. Gilliam have recieved honoraria from UCB Pharma)