Abstracts

Levetiracetam (LVT) is a newer anticonvulsant drug, first investigated in the 1980[apos]s as a drug with cognitive enhancing effects. In the 1990[apos]s pharmacodynamic studies were initiated in epilepsy. The early studies showed great promise in adults with partial onset seizures, leading to FDA approval in 2000 for adults. Levetiracetam has been gaining popularity for usage with pediatric patients as adjunctive therapy for both partial and generalized epilepsy. Although its popularity has increased, there is still little information available on its efficacy and safety in pediatrics, particularly in disease specific epilepsy such as tuberous sclerosis complex. This retrospective study was conducted to review both efficacy and safety in our pediatric epilepsy population.
We conducted a retrospective review of experience with LEV in our patient population from database and chart review. This data includes patients currently on LEV and those considered to have [quot]failed[quot] the medication. Most of the patients were on LEV in combination with other anticonvulsant medications, the ketogenic diet or the vagus nerve stimulator. Included in the analysis were several children with Tuberous Sclerosis Complex; data from these patients was also evaluated independently to assess for particular efficacy and tolerability. Data analyzed included age, seizure type and etiology, percentage seizure reduction, medications and dosages and side effect profiles. Data was also analyzed for children started on vitamin B6 supplementation after developing possible behavioral side effects from LEV treatment.
Over 90 patients in our population were treated with levetiracetam during the study period. In children with partial-complex seizures (n=25), 70% had a least a 50% reduction in seizures, and 60% were found to have a reduction of greater than 75%. Data on patients with generalized epilepsy (n=65) was similar to PCS, with over 80% of patients experiencing a greater than 50% reduction; 50% showed a greater than 75% reduction. Approximately 40% of children with generalized epilepsy reported a greater then 90% reduction in seizures. These results are limited by population size and because most of the children were on combination therapy during the study period. Efficacy was similar in a subset of children with Tuberous Sclerosis Complex. Several children were started on supplemental vitamin B6 (n=40) due to behavioral side effect of levetiracetam. Approximately 30% of these patients had a greater than 80% reduction of side effect.
Levetiracetam is an effective and fairly well tolerated antiepileptic drug therapy in childhood epilepsy, for both generalized and partial epilepsies. It is a well tolerated medication across a fairly broad dosage range, with the exception of behavioral side effects. In many children, vitamin B6 supplementation can result a reduction of behavioral side effects, allowing continuation of levetiracetam.
[Supported by: UCB Pharma]