Abstracts

Rationale: The efficacy and safety of levetiracetam (LEV) in the treatment of idiopathic generalized epilepsies (IGE) is increasingly established. Only recently, an injectable formulation for intravenous (IV) administration of LEV was licensed. Experiences concerning the use of IV LEV in absence status epilepticus (ASE) have not been reported previously.Methods: During video-EEG monitoring a 37-year-old male patient with IGE presented a habitual prolonged ASE, which was characterized by subtle but consistent attentional and executive disturbances as well as a cognitive slowing of gradually augmenting intensity. EEG showed discontinuously, but with increasing frequency generalized 3-5 Hz sharp-slow-wave-complexes. About 19 hours after clinical ASE onset neuropsychological examination revealed a marked reduction of cognitive speed and mental flexibility. Generalized epileptic activity was present in up to 60% of time in surface EEG. The patient eventually stated that the subjective impairment was not longer tolerable. Thus, 500 mg IV LEV were administered over a period of 5 minutes. After 20 minutes additional 500 mg LEV were infused over 15 minutes. Results: As soon as after application of 250 mg IV LEV the patient reported a significant relief; after infusion of 500 mg LEV he assessed that the normal state was reached. Repeated neuropsychological examination after IV administration of 500 and 1000 mg LEV, respectively, documented a dose-dependent improvement of the cognitive performance, which finally achieved normal values after application of 1000 mg IV LEV. Accordingly, a dose-dependent reduction of both the number of the generalized epileptiform potentials and the total of their duration was observed. The clinical and electrophysiological effect of IV LEV was sustained. Adverse reactions did not occur.Conclusions: In the present case, low-dose IV LEV led to an immediate and sustained interruption of an ASE lasting over 20 hours. As reported in complex focal status epileptici in focal epilepsies, also in IGE the administration of IV LEV may be an effective and well tolerated alternative option to the treatment of non-convulsive status epilepticus with benzodiazepines.