Abstracts

Rationale: Status epilepticus is a major cause of morbidity and mortality in epilepsy and intravenous anticonvulsant administration plays an important role in its management. Of the new anticonvulsant medications, only levetiracetam has become available in an intravenous form. At this time it is unclear whether intravenous levetiracetam has efficacy in the treatment of status epilepticus.Methods: This is a retrospective case series evaluating the patients who received intravenous levetiracetam as one of the agents used to treat status epilepticus. Results: Three patients were identified. Patient 1 was a 59 year old woman with multiple myeloma taking levetiracetam 500 mg daily for recent onset partial seizures. She presented with a posterior cerebral artery infarct, a subdural hematoma and epilepsia partialis continua. She was sequentially given four mg of intravenous lorazepam, 1000 mg of intravenous phenytoin, and 1000 mg intravenous and 1000 mg of oral levetiracetam. Her seizures finally abated with the addition of 1000 mg of sodium valproate. Patient 2 was a 67 year old man with post-traumatic epilepsy on valproic acid 750 mg twice daily and levetiracetam 500 mg twice daily who presented with nonconvulsive status epilepticus. He was given six mg of intravenous lorazepam, a total of 1850 mg of sodium valproate, and 3000 mg of intravenous levetiracetam. His seizures did not abate until he received intravenous phenytoin 1500 mg. Patient 3 was a 34 year old pregnant woman at 37 weeks gestation with Juvenile Myoclonic Epilepsy. She was taking lamotrigine 350 mg twice daily with stable serum levels. She presented with status myoclonus. She was given intravenous levetiracetam 1000 mg and her seizures abated within minutes of the infusion.Conclusions: Intravenous levetiracetam stopped status epilepticus in one of three cases in this series. Its role in the routine management status epilepticus remains uncertain. (Source of funding is UCB Pharma, Young Investigator Research Program.)