Abstracts

Levetiracetam is one of the newer antiepileptic drugs with linear pharmacokinetic profile, lack of drug interactions and ability to titrate rapidly make it a promising option for a broad spectrum of pediatric epilepsy patients.
Purpose: To establish the efficacy and safety profile of levetiracetam in children under 16 yrs of age . A retrospective case review of all children who have been placed on levetiracetam in the last 2 years (Jan 2003-Jan 2005). Information was collected on age and sex, seizure type, epilepsy syndrome, treatment with other Anti-epileptic drugs (AEDs), dose of levetiracetam and duration of treatment as of March 2005. Efficacy was based on seizure frequency and duration as reported by the patients and their caregivers. Adverse effects were also assessed. Thirty six patients aged 16 yrs and below were placed on levetiracetam during this time. The male to female ratio was 1.3. The age range was 21months to 16 years. Of the 36 patients, 33 were intractable. Of the intractable patients, 9(27%) had generalized tonic clonic seizures, 20 (60.6%) had partial onset seizures, 15 (45.4%) had partial onset with secondary generalization, 2 (6%) had tonic seizures, 1(3%) had atonic seizures, 2 (6%) had myoclonic seizures, 2 (6%) had atypical absence and 1 (3%) had absence seizures. Three (6%) patients had primary generalized epilepsy, 6 (12%) had symptomatic generalized epilepsy, 9 (27)% had cryptogenic partial epilepsy, 15 (45.4%) had symptomatic partial epilepsy.
The mean number of AEDs tried before starting levetiracetam was 3.7 (range 2-12) The mean number of concomitant medications was 1.1 of which phenobarbital, oxcarbazepine and divalproex sodium were the most frequent. The mean dose of levetiracetam was 44 mg/kg/day (range 12.9-100mg/kg/day). The mean period of follow up was 10 months. Response rate was categorized into 4 groups. Five (15.1%) patients were seizure free (100% response) for a mean follow up period of 8.5 months. Additional 2 patients had a 100% response initially which could not be sustained beyond 2 months. One patient had a sustained 75% reduction in seizure frequency. Six patients had 50% reduction but 2 could not sustain it beyond 2 months. Two patients had sustained 25% reduction in their seizure frequency. Fourteen (42%) patients did not have any decrease in their frequency or duration of seizures. Adverse effects were observed in 4 (12.1%) patients which included changing behavior, itchy rash and unsteadiness. Levetiracetam in our practice was mainly used for intractable epilepsy. Thirty percent patients showed a sustained reduction of more than 50% in seizure frequency. Another 12% patients showed an initial response which could not be sustained. Fourty two percent patients did not respond at all. Only 12 % patients had any side effects.
In summary levetiracetam is a useful drug as adjunctive therapy for intractable childhood epilepsy. (Supported by UCB Inc.)