Abstracts

Nonconvulsive status epilepticus (NCSE) in the context of acute medical problems is associated with substantial mortality. About 1/3 of NCSE cases are refractory to traditional antiepileptics and intermittent benzodiazepines. Treatment with high dose benzodiazepine or barbiturate to achieve burst-suppression EEG pattern can be effective, but failure rate and post-treatment recurrence rate are considerable in refractory cases. Moreover, intubation for airway protection is not always feasible. As levetiracetam (LEV) has a unique mechanism of action with minimal systemic side effects and is effective in treating chronic epilepsy, its use in NCSE is studied. We reviewed 9 consecutive cases of NCSE treated with levetiracetam (3/2004- 4/2005). These patients, aged 48-89, were diagnosed with NCSE by clinical observation and EEGs. Given 1-2 antiepileptics [plusmn] intermittent lorazepam, they showed no clinical and electrographic improvement before initiation of 500 mg LEV (1000 mg in case 9). Continuous i.v. infusion of midazolam (MDZ) was given at least 12 hours after LEV loading in case 6 and 8, and simultaneously with LEV in case 4. A successful response is defined as being seizure-free for at least one week. [table1]Successful control of NCSE was achieved in 5 of 9 patients treated with LEV as adjunct agent without MDZ infusion. Two of the non-responders died due to profound cerebral structural abnormalities. In cases treated with LEV followed by MDZ infusion, 2 out of 3 patients were seizure-free on LEV monotherapy. This study suggests that LEV may be effective in control refractory NCSE but less effective in conditions of severe intracranial abnormalities. Further investigation is necessary. (Supported by Dept. of Neurology, RWJ Medical School.)