Abstracts

Children presenting continuous spikes and waves during sleep (CSWS) display neurological or neuropsychological dysfunction associated with a specific EEG pattern. It is widely accepted that anti-epileptic drugs (AEDs) should suppress or significantly diminish the epileptiform discharges as neurological dysfunction is often concomitant to the arising of CSWS. Corticosteroids and benzodiazepines are efficient in some patients but adverse effects limit their use. Levetiracetam (LEV) could be indicated in the treatment of syndromes with CSWS: indeed, studies performed in animals as well as in humans have shown that LEV is able to diminish the interictal epileptiform discharges. The aim of this pilot study was to test the efficacy of LEV on sleep EEG record and neurological status in epileptic children presenting CSWS.
Four children aged 4 to 14 years presenting cognitive deficits and a typical EEG pattern (more than 85 % of spikes and waves during slow sleep) were selected. The neurological deficit consisted in moderate to severe mental retardation in 3 patients, and global psychomotor retardation with ataxia in the youngest one. The etiology of the epileptic syndrome was unknown in 3 cases (cryptogenic cases) and was a chromosomal aberration in one case. In all the patients, trials with conventional AEDs had failed and 3 of them had previously been treated with corticosteroids without significant benefit. The patients received 25 mg/kg/d LEV during the first two weeks and then 50 mg/kg/d. Usual AEDs were not changed. A clinical and EEG reevaluation including sleep study was performed after two months of treatment
Are listed in Table 1. LEV was well tolerated in all the patients. Disappearance of CSWS together with improvement in neurological condition were achieved in 2 patients (patients 3 and 4). Detailed neuropsychological evaluations were not available in these 2 patients because of severe mental retardation, but behavioral improvements were observed: patient 3, who had no language acquisition, could use a few words and was less aggressive, and patient 4 was more alert and cooperative . Patient 1 showed the persistence of CSWS but overt seizures were no longer observed and her clinical condition was improved (she was more alert, less ataxic and able of new language acquisitions). No clinical nor EEG benefits were observed in patient 2.
These preliminary results suggest that LEV is useful in the treatment of epileptic syndromes with CSWS. This should encourage long term studies in a larger population to better define the place of LEV in the treatment of these epileptic conditions.[table1]