Abstracts

Rationale: Levetiracetam is a newer anticonvulsant with a pharmacological profile (non-protein bound, significant renal excretion, lack of enzyme induction) which facilitates its use in a wide range of complex clinical settings. The recent availability of an IV formulation particulary recommends its use in stroke patients when the use of a commonly used agent like phenytoin is clinically difficult due to anticoagulant therapy, or neurological compromise limits the use of oral anticonvulsant therapy.Methods: A list of all patients recieving IV levetiracetam was obtained from a pharmacy database and a retrospective chart and electronic medical record review was undertaken. Data extracted included age, sex, stroke syndrome, comorbid conditions, seizure type, clinical scenario (first seizure, recurrent seizures, concomitant anticoagulant use) doses used, use as loading or maintenance therapy, whether used as monotherapy or adjunctive treatment, serum concentrations where available, tolerability, efficacy and side effect profile. Results: Intravenous levetiracetam was used in 22 patients who developed seizures in the setting of acute or pre-existing stroke. The patient population was much older than the general population recieving anticonvulsant therapy and there was a higher incident of co-morbid chronic medical illness. In addition most patients were taking multiple other medications and in many cases anticoagulant therapy with Coumadin was either ongoing or in the process of being initiated. Intravenous levetiracetam was well tolerated in this population with no recorded acute adverse events attributed to levetiracetam therapy, during or in the 24 hours after administration, despite the overally greater morbidity in the population under study. A majority of patients were discharged from hospital on levetiracetam maintenance therapy, a significant number of whom were taking it a the sole anticonvulsant agent on discharge.Conclusions: Intravenous levetiracetam appears to be a useful addition the limited range of intravenous anticonvulsants available for use in the stroke patient, particularly in the intensive care unit setting. Its pharmacological profile recommends it use in the patient taking multiple other medications where the addition of a more commonly used agent like phenytoin would potentially complicate therapy. The lack of any pharmacokinetic interaction with anticoagulant therapy is particularly useful in this population. Supported by an educational grant from UCB Pharma.