Abstracts

Levetiracetam is a newer anticonvulsant with several pharmacological properties which favour its use in the elderly, particularly in a hospital based population with multiple medical co-morbidities.
The compound is renally excreted, non-protein bound, it neither inhibits nor induces liver enzymes and steady state concentrations are acheived quickly, permitting early hospital discharge.
Levetiracetam is highly water souluble which allows administration via nasogastric tube and the recommended starting dose of 500mgs twice daily is theraputically effective. A list of all patients who recieved levetiracetam while admitted to Loyola University Medical Center in 2004 was obtained through a pharmacy database. 39 of these patients were aged 65 or older.
We reviewed the use of levetiracetam under the following headings; indication for use, etiology of seizures, use in an intensive care unit as opposed to general ward setting, use as first-line therapy as opposed to monotherapy, numbers of concomitant medications, co-existing anticonvulsant therapy, and dose range. Results indicated a striking divergence in use of levetiracetam in the population surveyed compared with the general population of patients recieving anticonvulsants.
54% of the patients recieved levetiracetam while admitted to a neurosurgery or trauma service, the most common underlying cause of seizure was intracranial hemorrhage, particularly sub-dural hemorrhage.
The majority of these patients (80%) recieved levetiracetam as first-line monotherapy, and had not been exposed to previous anticonvulsant use.
The second largest group (38%) was comprised of patients with stroke, again a majority recieved levetiracetam as first-line therapy.
The most common setting for initiation of levetiracetam therapy was in an intensive care unit setting, with the 500mgs twice daily being the starting dose in 85% of patients.
The average number of medications being taken at discharge was 9.4, with a range from 4 to 18 prescriptions.
Only 12% of the patients who recieved levetiracetam were already taking an anticonvulsant, with phenytoin being the preexisting medication in all cases apart from one. The pattern of use indicated in our results indicates that levetiracetam monotherapy is a frequently chosen option in the intensive care unit setting, particularly in neurosurgical patients.
The lack of interaction with other medications through protein binding or enzyme induction makes levetiracetam a particularly attractive alternative in a population where the average number medications taken on disharge is greater than 9.
Relatively low doses of levetiracetam were used in this population, and of the surviving patients a majority continued to take the initial dose of 500mgs twice daily at follow-up.
Levetiracetam provides a valuable option for the treatment of seizures in an elderly hospital-based population. (Supported by UCB Pharma.)