Abstracts

Rapid administration of anti-epileptic drugs (AEDs) is often necessary in the treatment of pediatric patients with intractable seizures but significant and often prolonged adverse reactions can occur. Levetiracetam ([italic]Keppra[/italic]) is a well-tolerated oral AED with few significant adverse effects even at high doses. Levetiracetam may be a safe, well-tolerated option when enteral AED loading is indicated. The records of 9 patients ages 3-16 years old with intractable seizures (generalized or partial) were reviewed. All were on other AEDs, clinically conscious and interactive, and monitored with video EEG and pulse oximetry at the time of levetiracetam administration. In the first 24 hours, 30-40mg/kg of levetiracetam in 2-3 divided doses was given orally or via gastric tube. 40-50mg/kg/day dosing divided twice daily began the following day. Patients were clinically evaluated daily by a neurologist for adverse effects. Seven of the 9 patients developed sedation during the first 24 hours of administration but could communicate and interact at their normal levels. Only one of these patients had clinically significant sedation beyond 3 days. One patient became hyperkinetic during the loading period without significant irritability or interference with sleep. Normal levels of activity gradually returned over 2 weeks. One patient had no apparent clinical adverse reaction. Ambulation and coordination in 6 patients (3 patients were non-ambulatory since birth) were not affected by levetiracetam administration. Oxygen saturations did not significantly change. Loading levetiracetam orally or via gastric tube appears to be well tolerated by pediatric patients with intractable seizures. Adverse effects were mild, temporary and did not lead to discontinuation or dose adjustment of the drug. Further study of the range of adverse reactions and the efficacy of levetiracetam loading is needed.