LEVITERACETAM MONOTHERAPY
Abstract number :
1.306
Submission category :
Year :
2003
Submission ID :
2082
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Beth Korby, Patricia E. Penovich, John R. Gates, Deanna L. Dickens, Gerald L. Moriaraty Minnesota Epilepsy Group, PA of United Hospsital and Children[apos]s Hospital and Clinics-St Paul, St Paul, MN; Department of Neurology, University of Minnesota, Minne
Leviteracetam (LEV) has been approved for adjunctive use in refractory partial epilepsy. Its pharmacokinetic advantages and unique mechanism of action have led to increasing use. Sporadic reports of LEV efficacy in monotherapy led us to review what our experience has been over the last 3 years in a large population of patients with refractory epilepsy, new onset epilepsy and epilepsy secondary to newly diagnosed CNS neoplasm.
A retrospective chart review of patients receiving LEV was performed for monotherapy patients. Data was tabulated for age, gender, IQ, behavioral and psychogical history, medication history, seizure frequency, adverse effects (AE), LEV doses and serum levels.
36 patients reached LEV monotherapy (LEV-M): 3 (8%) de novo, 33 (92%) transitioned from another AED. Six (17%) had primary CNS neoplasms. 32 (89%) remain on LEV-M, 1 required additional AED, 3 dropped due to AEs. Doses ranged from 250 to 3000 mg per day (mean 1389, median 1000). Serum levels ranged from 2-36 ug/ml (mean 15.9, median 12.5). Seizure freedom is present in 26 (72%) over 3-35 months (median 19, mean 17). Tumor patients are seizure free in 83%. AEs were reported in 42% (n=15) at some time, resolving with lowering dose in 3 (8%). Only 3 (8%) discontinued LEV due to AEs. Reported AEs were hand tremor 27%, tiredness or weakness 20%; ataxia, irritability, decreased memory, cognitive decline 13% each ( 2 each); single reports of tinnitus, headache, weight gain, decreased libido, increased dreaming, increased depth perception, dizziness. Fourteen patients (39%) had a past history of behavioral or psychological problems prior to LEV therapy; 2 of these patients reported additional problems while on LEV-M, while 12 did not. Six patients with depression and mood swings reported improved psychiatric status.
LEV-M offers significant benefit for patients with epilepsy. Seizure control can be excellent. Most AEs are temporary and well tolerated. Those with a previous history of behavioral or psychiatric problems did not experience intolerance to LEV at any increased rate. A subgroup with depression and mood swings improved. LEV monotherapy may be achieved without difficulty in patients with refractory epilepsy and in patients with primary CNS neoplasms.