Abstracts

Rationale: Status epilepticus and acute repetitive seizure is neurological emergency because of high rate of morbidity and mortality and having a significant neuronal injury after treatment. So, the acute management of seizure is crucial. Intravenous levetiracetam (IV-LEV) which is 2nd-generation anticonvulsant was approved in 2006 for used adjunctive treatment of partial seizures in patients older than 16 years and could be useful in critically ill children. We aim to investigate the effectiveness and tolerability of IV-LEV for seizure exacerbation in children, and the related factors for the seizure outcomes.Methods: We performed a retrospective chart review of children who received IV-LEV for status epilepticus and acute repetitive seizures between 2010 and 2014. Patients were divided into two groups according to seizure outcomes: seizure-free (SF) vs no seizure-free (NoSF) groups.Results: Seventy-three children (mean age, 4.3±5.0 years) had received IV-LEV loading (mean dose, 42.4±13.4 mg/kg) to abort their seizures. Fifty of 73 (68.5%) had the SF outcomes for more than 48 hours. Mean age was similar in SF and NoSF groups (4.8±5.4 vs 3.3±4.1 years, p=0.271). SF group showed significantly frequent generalized seizures (72.0% vs 21.7%, p<0.005) and higher initial doses (45.7±11.7 vs 35.2±14.5 mg/kg, p=0.002) than in NoSF group. The findings of diffuse voltage attenuation (26.1% vs 2.0%, p=0.003) and multiple independent spike foci (43.5% vs 6.0%, p<0.001) on EEG recordings after the IV-LEV therapy were more often found in NoSF group than in SF group. Two children discontinued LEV therapy because of irritability and aggressive behavior.Conclusions: IV-LEV was effective and tolerated in terminating acute prolonged seizures in children, especially with generalized seizures or with higher loading doses of IV-LEV. EEG study during the interrupted seizures may be helpful predict the following related seizures.