Abstracts

Rationale: To determine efficacy and tolerability of intravenous levetiracetam in infants and toddlers presenting with prolonged or recurrent serial seizures. Methods: Children 0 days through 4 years of age who received intravenous levetiracetam were retrospectively identified from inpatient pharmacy records. Charts of these children were reviewed to select those who received levetiracetam for either a prolonged seizure (15 minutes or longer) or recurrent serial seizures (defined as three or more seizures within a 24 hour period). Efficacy and tolerability of levetiracetam was assessed for each child, and potential predictors of efficacy examined. Results: 19 children, aged 0 days through 4 years were identified (12 M, 7 F). Four were treated for a single prolonged seizure, while 15 had suffered serial seizures. Nine (47%) were known to have epilepsy and on prophylactic AEDs at the time of their presentation. Three children (16%) received levetiracetam as their initial therapy, while the remainder had failed other abortive agents (mean 1.7, range 1-3). Fourteen (74%) had failed abortive benzodiazepine therapy. The mean initial and total dose administered was 17.5 mg/kg (SD 4.8, range 10-25) and 22.2 mg/kg (SD 19.3, range 10-100) respectively. Levetiracetam was effective in aborting the seizure activity in 8 (42%) of cases. Efficacy did not correlate with initial or total dose, number of abortive AEDs used, prior benzodiazepine use, seizure type, delay to treatment, age or etiology, however males tended to be more likely to respond (p=0.07). Intravenous levetiracetam was well tolerated, with no serious adverse effects noted in any child. Conclusions: Intravenous levetiracetam was effective at controlling prolonged or recurrent serial seizures in 42% of children younger than 4 years and was not associated with any serious adverse effects in this small study.