Abstracts

RATIONALE: At the end of this activity the participants should be able to discuss how to initiate levetiracetam therapy quickly, safely and effectively.
METHODS: Eleven patients (nine inpatients, two outpatients) received rapid initiation of LEV therapy: a dose of 3,000 mg per day by the third day of therapy. All patients had partial onset seizures with or without secondary generalization. LEV was dosed at 500 mg bid on day one, 1000 mg bid on day two and 1500 mg bid on day three.
This rapid titration was indicated due to poor seizure control or unacceptable side effects on the previous AED regimen. The majority of patients underwent simultaneous discontinuation of one or two concomitant AEDs.
RESULTS: Ten of the eleven patients tolerated rapid initiation of LEV with minimal or no side effects. Four patients became seizure free on LEV therapy. No patient experienced worsened seizure control, despite the fact that most patients had one or two concomitant AEDs withdrawn.
One patient experienced hallucinations, and LEV was stopped. She was the oldest patient (sixty-three years old) and was the only patient who experienced status epilepticus before treatment. She may have had post-ictal psychosis.
One patient had experienced post-ictal psychosis twice in the past, but he tolerated rapid initiation of LEV therapy without difficulty and became seizure free.
CONCLUSIONS: LEV is a recently introduced AED which offers desirable pharmacokinetic qualities: no clear drug/drug interactions, no metabolism by the P450 enzyme system and no significant protein binding. Pharmacokinetics are linear and steady state is achieved rapidly. Prescribing information recommends a gradual titration with the maximum recommended dose reached after one month of therapy. This gradual titration limits the usefulness of LEV in circumstances which require rapid control of seizures or rapid withdrawl of other, poorly tolerated AEDs.
As described, rapid titration of LEV is effective and well tolerated by most patients