Abstracts

Head trauma is a well-known cause of epilepsy. It is the leading known cause of epilepsy in the 15-34 year age group. Several trials have shown lack of efficacy with the established antiepilepsy drugs (AEDs) in preventing the development of seizures following head trauma. However, very few trials have looked at use of a specific AED after the onset of seizures following head trauma. Between the time period of Dec 1, 2002 and June 30, 2003, patients at Penn State, Milton S. Hershey Medical Center[apos]s Adult Epilepsy Center were evaluated for etiology of uncontrolled seizures. Inclusion criteria included a clear history of head trauma preceeding onset of seizures, abnormal imaging study, uncontrolled seizures despite trial of at least 3 other AEDs, and use of only 1 or 2 additional AEDs at the time of the study. Exclusion criteria included: head trauma complicated by other factors such as infection or shunt placement; additional risk factors such as febrile seizures, family history, prior history of seizures; or prior history of another head trauma. Patients meeting criteria had levetiracetam (LEV) added to pre-existing AEDs. Dosage of levetiracetam was titrated upward based on adverse events and response to treatment. Patients maintained a diary with seizure counts and adverse events. Seven patients met the criteria for the study. Onset of seizures following head trauma ranged from 2 weeks to 12 years with the age at the time of injury ranging from 4 months to 51 years. Duration of epilepsy ranged from 3 years to 34 years. Six of the 7 patients became completely seizure-free following the addition of LEV. The 7th patient had a 75% reduction in seizures. The dose of LEV ranged from 1000 mg/day - 5000 mg/day. Four patients were on one additional AED and 3 were on 2 additional AEDs. Treatment ranged from 10 months to 16 months. Response to therapy did not change over time. No patients discontinued LEV. One patient listed [quot]short temper[quot] as an adverse event. No other behavioral side effects were noted. Addition of LEV to existing AEDs produced a very high response rate in patients with intractable epilepsy that was related to head trauma. Future trials in a closed-label manner would be necessary to further evaluate the response to LEV in this group of epilepsy patients. Additional areas to investigate that would be of interest would include titrating to LEV monotherapy, specific response rates to region of brain injured or cause of injury, inclusion of patients with head trauma but no imaging abnormalities, and preventative therapy of LEV in head trauma patients prior to development of epilepsy.