Abstracts

RATIONALE: To evaluate the efficacy of levitiracetam in adults with brain tumors and intractable partial seizures. From this study, the participants should be aware of the treatment options in patients with brain tumors and uncontrolled partial seizures.
METHODS: All patients with brain tumors and uncontrolled partial seizures who were seen by the authors between March 2000 and March 2002 were offerred all antiepileptic drug (AED) therapy alternatives. Patients with either primary brain tumors and metastatic tumors were included. Benefits and risks of each AED were detailed. Each patient was followed by the same epileptologist, and seizure frequency as well as side effects were assessed at each follow up visit. Initial target dose of levitiracetam was 500 mg bid over 1 week. Additional increases or decreases in the levitiracetam dose was based on clinical response to drug and side effects.
RESULTS: Of 38 patients identified (14 astrocytomas, 8 glioblastoma multiforme, 10 oligodendrogliomas, 1 each hemangiopericytoma, meningioma and primary CNS lymphoma, and 3 metastatic tumors), 30 elected to initiate levitiracetam therapy. Adjunctive AED therapy consisted of 1 to 4 AEDs in all but 2 patients who presented with acute allergic reations to recent AED therapy which was subsequently discontinued. Levitiracetam dosages ranged from 250 mg to 3500mg per day (median of 1750 mg and mean of 1826 mg). With 2 to 18 months follow up, 8 patients have become seizure free and 7 patients have had greater than 90% reduction in seizures. In 6 patients there was no significant improvement, with 1 patient having worsening of seizures. Three patients (1 seizure free) are on levitiracetam monotherapy, 2 of which entered on no AED due to recent AED allergic reaction. Excessive sedation was noted in 3 patients, requiring dose reduction or discontinuation. In 14 of 30 patients, phenytoin (200 mg to 400 mg per day) was the adjunctive AED.
CONCLUSIONS: Levitiracetam is effective and can be successfully introduced quickly in patients with brain tumors and intractable partial seizures. Many patients can be adequately contolled with dual therapy using levitiracetam, and monotherapy can be achieved in some cases. Rapid transition to levitiracetam is possible in patients with AED allergic reactions with good outcome.
(Disclosure: Consulting - Elan, Excel, UCB Pharma, Glaxo Smith Kline, Honoraria - Elan, Excel, UCB Pharma, Glaxo Smith Kline)