Abstracts

RATIONALE: Levetiracetam (LEV) was approved for use in patients 16-years of age and older as an adjunctive treatment for partial onset seizures, and launched in the USA in April 2000. Since then there has been little information regarding its use in children, particularly young children. The objective of this study is to better understand the use of LEV in children [lt]2-years of age.
METHODS: We reviewed our use of LEV in children [lt]2-years of age at Minnesota Epilepsy Group, PA[reg]. Patients who were [lt]2-years of age at the time they were started on LEV were identified. Their records were reviewed for starting dose (mg/kg), maximum dose (mg/kg), titration rate, tolerability and efficacy. Seizure type/epilepsy syndrome were also documented. LEV levels, blood counts and serum characteristics were not routinely drawn in all patients.
RESULTS: Twenty-two children [lt]2-years of age were identified. Ages ranged from 2-days to 21-months. There were four new onset seizure disorders, the remainder having different epileptic syndromes (including infantile spasms). Initial dosages ranged from 10-mg/kg/day to 41 mg/kg/day (median 18.4-mg/kg). The maximum dosages ranged from 15-mg/kg/day to 144-mg/kg/day (median 61.25-mg/kg) and was achieved after several days to six weeks. Four patients received LEV as their first anticonvulsant. Six patients received LEV as their second anticonvulsant. Six patients received LEV as monotherapy. 12/20 patients continued LEV. Two patients were lost to follow-up. Six patients were reported to have side-effects that included a slight increase in hyperactivity, becoming a [dsquote]zombie,[dsquote] or fatigue (as described by caregivers). Side-effects did not appear related to titration rate or maximum dose. Of the eight patients known to discontinue LEV one discontinued due to side-effects, seven were due to a lack of benefit. Of 20 patients, four patients were seizure-free, six had a [gt]90% reduction in seizures and eleven patients had a [gt]50% reduction in their seizures. Nine patients did not have a significant change
CONCLUSIONS: LEV appears to be a safe, well-tolerated and effective anticonvulsant in young children. A faster titration rate and higher maximum dose were used in these children without an increase in significant side-effects. Therefore, LEV may be considered as a first-line anticonvulsant in neonates and children [lt]2-years of age.
(Disclosure: Honoraria - Yes.)