Tolerability of Levetiracetam in Children with Refractory Epilepsy
Abstract number :
1.178
Submission category :
Year :
2001
Submission ID :
2117
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
E. Wannag, MD, The National Center for Epilepsy, Sandvika, Norway; A-S. Eriksson, MD, PhD, The National Center for Epilepsy, Sandvika, Norway; F.K. Brockmeier, MD, The National Center for Epilepsy, Sandvika, Norway
RATIONALE: Clinical data are limited on the use of levetiracetam in children. The aim of this prospective study was to determine the tolerability of the drug in children with refractory epilepsy.
METHODS: We studied 45 children with a mean age of 10 years (range: 3-17 years). Age of epilepsy onset was 2.8 years (range: 0-10 years). Twenty-one patients had partial epilepsies and 24 patients had multifocal/generalized epilepsies.
Before treatment with levetiracetam they had tried on average 9 antiepileptic drugs (range: 5-12). Five patients had tried ketogenic diet, 5 vagus nerve stimulation, and 2 had previously undergone epilepsy surgery. Levetiracetam was given as add-on medication with an initial dosage of 10 mg/kg/day, increasing with 10 mg/kg/day every forthnight to a maximum dosage of 40 mg/kg/day.
RESULTS: The observed side effects were ataxia, dizziness and lethargy (n=3) and [dsquote]forced normalization[dsquote] (n=1). Approximately 50% of the patients had a significant seizure reduction ([gte]50%) on doses between 10 and 20 mg/kg/day. Only about 30% had such an effect on 30 mg/kg/day, and only 5% on 40 mg/kg/day. Despite initial good response of levetiracetam the seizure frequency increased with doses of 30 mg/kg/day or higher in as many as 19 of the 45 patients (42%), and three of them had impending status epilepticus. After an observation period of 3-5 months 27 of the 45 patients (60%) still used levetiracetam.
CONCLUSIONS: Levetiracetam was well tolerated in most children. We propose that the drug should be introduced with caution in younger children due to the tendency of increased seizure frequency over time despite a good initial response. A prospective study is ongoing to examine the effect and tolerability of levetiracetam in children in relation to plasma drug levels.
Support: No fundings