Abstracts

Rationale: Paradoxical reactions including exacerbation of seizures have been reported for a number of anti epileptic drugs (AED). Levetiracetam (LEV) is a widely used newer anti epileptic medication with a favorable pharmacokinetic profile and few adverse effects. Only one prior study has reported exacerbation of seizures by LEV. In this study we present data on significant exacerbation of seizures by LEV. Methods: We retrospectively reviewed medical records of all children with epilepsy and LEV related seizure exacerbation (n=6), who had their care for epilepsy at Children's Hospital Boston. The study was approved by the institutional review board at Children's Hospital Boston. Clinical information was reviewed including response to LEV with increase in seizures. Baseline seizure frequency was measured up to 6 months prior to exacerbation. Results: Mean age was 4.8 years (range (years): 1.2-14.11). The most common seizure etiology was complex partial seizures(Table 1). Mean LEV dosage was 106.4 mg/kg/day (range: 25.2-232 mg/kg/day). Complex partial seizures were exacerbated in three patients, generalized and myoclonic seizures in one each. Two patients experienced a new type of seizure. All children had an at least two fold increase in seizure frequency (Table 2). Conclusions: This study demonstrated dramatic increase (at least two fold) in seizures within 1 month of LEV initiation, which was reversed with discontinuation of LEV. Such a marked exacerbation of seizures has not been previously reported with LEV. Seizure exacerbation was not clearly associated with seizure etiology. Although LEV is a safe and effective AED, it is important to understand that seizure exacerbation may occur, especially at higher doses.