Abstracts

The use of levetiracetam in the intensive care unit (ICU) has limited data. Phenytoin, a standard antiepileptic drug (AED) has numerous challenges in relation to dosing, administration, and adverse effects. Levetiracetam, a newer antiepileptic agent has a limited side effect profile and does not affect the cytochrome P450 pathway. This retrospective review will look at the use of levetiracetam in the ICU patient population at the University of Illinois Medical Center at Chicago (UIMCC) to date. The primary objective is to determine if levetiracetam is effective in preventing and/or treating seizures clinically and per electroencephalogram (EEG). The secondary objectives are to determine the safety and tolerability, the reasons for initiating, and the usage pattern of levetiracetam in the ICUs at UIMCC., This study is a retrospective chart review of patients who received levetiracetam while in the ICU. Patients are included in this study if they are initiated on levetiracetam during January 2002 through October 2005 while they are hospitalized in the ICU. Exclusion criteria are patients [lt] 18 years of age and pregnant females. Data collected includes patient demographics, renal and liver function, EEG results, observed seizures in daily progress notes, dose of levetiracetam started, final dose of levetiracetam, rate of titration of dose, reason levetiracetam started, other AEDs patients receiving during hospitalization, and adverse events suspected of other AEDs and/or levetiracetam. Patients will be followed until levetiracetam is discontinued, patient is discharged from the hospital, or death occurs., Preliminary results are available for 100 patients. Sixty-four percent of patients were admitted to the neurosurgical intensive care unit (NSICU). The most frequent initial dose (41%) and the most common final dosage (27%) of levetiracetam was 500 mg every 12 hours. Only 49% of patients had their dosage titrated up during hospitalizations. Most patients were either previously or currently on phenytoin as monotherapy (48%). Fifty-seven percent of patients were initiated on levetiracetam secondary to drug interactions or adverse effects of traditional AEDs. The most common adverse effect possibly related to levetiracetam was lethargy (8%). Eighty-seven percent of patients did not have a clinic seizure occur. Preliminary EEG results are available for 47 patients. A trend in reduction of ictal and interictal epileptiform activity was observed after initiation of levetiracetam and it appears EEGs improve as levetiracetam is continued., Levetiracetam is well tolerated in ICU patients and it is frequently initiated because of adverse effects and drug interactions of other AEDs. Based upon preliminary data, levetiracetam appears to have beneficial effects on EEG activity., (Supported by An unrestricted grant from UCB Pharma, Inc.)