Abstracts

Rationale: Levetiracetam (LEV) has been available in Germany as an intravenous (IV) formulation since 2006, for use in patients unable to receive oral therapy. We assessed the efficacy of IV LEV in the treatment of various types of status epilepticus (SE).Methods: For treatment of simple partial, complex partial and myoclonic SE, 1000 mg LEV was administered as a 15 minute infusion (in 100 mL NaCl 0.9%). For treatment of generalised tonic-clonic, nonconvulsive and subtle SE, the same dosage was administered fractionated in smaller volumes (500 mg in 20 mL NaCl 0.9%, given twice). Efficacy was assessed using termination of SE as the effectiveness criterion. For patients in whom SE was terminated, LEV therapy was continued using oral doses of 2000 mg/day. No further IV LEV was given to patients in whom SE was not terminated. Tolerability was assessed by evaluating treatment-related adverse events (AEs).Results: Since its launch in 2006, we have used IV LEV to treat 22 patients with various types of SE. In general, LEV was administered as second-line therapy, after benzodiazepines. LEV was most effective in the treatment of myoclonic SE, since seizures stopped without exception after LEV infusion (2/2). LEV was more effective in terminating simple partial (2/3) and complex partial (4/7) SE than nonconvulsive (1/3) or subtle (1/2) SE. For the treatment of generalised tonic-clonic SE, LEV was not sufficient at a dosage of 1000 mg (0/5), and the supposed faster effect of fractionated application of smaller volumes was without benefit. No serious AEs were reported. Prolonged somnolence (especially in elderly patients) was reported, but it was difficult to distinguish between this and post-seizure twilight state. Conclusions: LEV treatment may be more effective for myoclonic, simple partial and complex partial SE than for generalised tonic-clonic SE. Prospective studies of the efficacy and safety of LEV in the treatment of various types of SE should follow.