Abstracts

RATIONALE: This paper documents the effectiviness of add-on levetiracetam in a cohort of adults with mental retardation and intractable seizures attending an outpatient based seizure clinic.
METHODS: Eighteen Patients were chosen to recieve leviteracetam based on the lack of efficacy of previously available medication used over many years of attendance. This report documents the results of the whole series of patients. The analysis covers the first three months of treatment. The results are expressed in percentage change in average number of seizures per month before treatment and at the point of analysis some three months later.
RESULTS: One patient relocated and was lost to follow up.
Of the seventeen remaining, 25% (4) were seizure free; 37.5% (6) had a reduction [gt]50%; 12.5% (2) had a 31 to 50% reduction; a further 12.5% (2) experienced a reduction of less than 30% in their seizures. The remaining 12.5% (2) experienced a seizure increase. One of these was slight amounting to 10%, the other was severe amounting to 140%.
Two patients had their levetiracetam discontinued. One was because of increased seizures. The second had been seizure-free but developed a post-ictal psychosis and carers and relatives strongly requested that the medication be discontinued; this has been recently slowly reintroduced.
The dose range of the seizure-free group was 250mg twice daily to 1000mg twice daily. Concomitant reduction in other AEDs is now taking place. In the improved group , the levetiracetam is being increased and/or concomitant AEDs reduced.
The mean number of concomitant AEDs prior to the introduction of levetiracetam was 2.1 ( Range 1-3).
Patients had been treated with a range of traditional and novel AEDs (see table)
CONCLUSIONS: Adults with mental retardation have higher rate of intractable seizures than other adults with epilepsy. Levetiracetam is a long awaited novel AED which has now become available in Europe.
This series demonstrates that in adults with mental retardation and established histories of seizure intracability, levetiracetam can be highly effective both in terms of being seizure-free and in reduction of seizures of [gt]50% and that this can be achieved within a very short time without undue toxicity.
Further controlled studies are required to authenticate these encouraging findings.[table]
Support: No funding was sought for this study.
Educational support has been recieved by this department from several pharmaceutical companies.