Abstracts

RATIONALE: In late 1999, levetiracetam was approved by the Food and Drug Administration for the treatment of partial seizures in adults. Recent studies have indicated that it is effective in other seizures types as well. In addition, it may reduce the number of interictal epileptiform discharges when given as a single dose. However, there are no reports of seizure worsening during treatment with levetiracetam. We present a small population of patients with refractory epilepsy whose seizures either increased in frequency or who experienced a new seizure type while receiving levetiracetam.
METHODS: We conducted a retrospective chart review. Patients had received levetiracetam for at least one month, were on polytherapy, and carried the diagnosis of either localization related epilepsy or generalized epilepsy.
RESULTS: We identified 8 patients whose refractory seizures increased in frequency or who began experiencing a new seizure type while receiving levetiracetam. 5/8 were women. Their ages ranged from 16 to 41 years (average 25). The duration of their epilepsy was 2 to 41 years (average 14 years). They had tried between 2 to 10 antiepileptic medications before starting levetiracetam, and were on 1-4 antiepileptic medications at the time that levetiracetam was started. Two had also been implanted with the vagus nerve stimulator (VNS). 7/8 were diagnosed with symptomatic localization related epilepsy, and 1 had idiopathic generalized epilepsy (juvenile myoclonic epilepsy). Of the seven who had partial seizures, 2 had undergone previous epilepsy surgery, and two had abnormalities on MRI (one with heterotopia and one with mesial temporal sclerosis). All 8 experienced an increase in the frequency of seizures. In addition, 2/8 developed a new type of seizure.
CONCLUSIONS: Levetiracetam is an effective treatment of both partial and generalized seizures. In this series, there were 8 patients with refractory epilepsy whose seizures worsened during treatment with levetiracetam: it caused an increase in seizure frequency in 8, and the appearance of a new seizure type in two of the patients. The exacerbation occurred in persons with localization related epilepsy (7/8) and generalized (1/8) epilepsy. Although this is a small series, these results suggest that levetiracetam may cause a worsening of seizures or the emergence of a new seizure type in patients with refractory epilepsy.