Abstracts

Rationale: Levetiracetam is a pyrolidone derivative that has high oral bioavailability, rapid absorption, and no interactions with other drugs. For these reasons, it is frequently prescribed as an initial antiepileptic medication, although it is only approved as an adjunctive therapy. Methods: We performed a retrospective chart review of new onset pediatric seizure patients. Patients were captured over a 2 year period from 9/1/2008-9/1/2010 and followed until 5/31/2012 in a general neurology practice in a community based academic children's hospital. A total of 301 patients up to age 17 years with new onset seizures were evaluated for efficacy judged by responder rate and seizure freedom, side effects, and retention. Neonates and patients with acute symptomatic seizures were excluded. Results: 66% (198/301) of the patients were initially placed on levetiracetam. 70% (139) of the patients were determined to have seizures focal in onset and 28% (56) were primarily generalized. 3 patients were undetermined in seizure onset. Of the 198 patients on levetiracetam, 65% had >50% reduction in seizures (63% of focal and 70% of generalized) and 32% became seizure free (35% of focal and 25% of generalized). In patients with focal onset seizure, responder rate was similar between levetiracetam and oxcarbazepine, as 63% (88/139) of patients responded on levetiracetam and 54% (25/46) on oxcarbazepine (p=0.26). Seizure freedom rate was also similar with 35% (48/139) of patients on levetiracetam and 30% (14/46) of patients on oxcarbazepine (p=0.66). Patients with multiple seizures per day were less likely to become seizure free (15% with multiple seizures per day vs. 41% without multiple seizures per day) on levetiracetam monotherapy (p<0.01), but there was no difference in responder rate of 50% reduction in seizures (67% vs. 65%, p=0.84). 59% (116/198) continued on levetiracetam as monotherapy throughout the study period. The mean retention time on levetiracetam as monotherapy was 21.6 months (1-39). 44 patients (24%) discontinued levetiracetam. 41 (21%) switched to another medication and 3 (1.5%) elected no medication. 61% discontinued due to side effects and 39% discontinued for ineffectiveness of levetiracetam as monotherapy. 34 patients (17%) continued levetiracetam but added another antiepileptic medication. Of those not started on levetiracetam as initial monotherapy, 30% switched to levetiracetam as second treatment. Side effects occurred in 65 patients (32%) on levetiracetam. The majority of these were related to behavior problems (95%), with 13 patients suffering severe enough side effects to discontinue the medication. Conclusions: Levetiracetam was safe and effective as initial monotherapy in pediatric patients with new onset seizures.