Levetiracetam Adjunctive Therapy for Refractory Pediatric Focal-Onset Epilepsy.
Abstract number :
1.169
Submission category :
Year :
2001
Submission ID :
956
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
V.C. Faircloth, MD, Pediatrics, Penn State Childrens Hospital, Hershey, PA; S.L. Hunt, CRNP, Pediatrics, Penn State Childrens Hospital, Hershey, PA; L.A. Yuncker, CRNP, Pediatrics, Penn State Childrens Hospital, Hershey, PA; T.F. Barron, MD, Pediatrics, P
RATIONALE: To retrospectively evaluate the effectiveness of levetiracetam (LVT) adjunctive therapy in children with refractory focal onset epilepsy.
METHODS: Children with refractory focal onset seizures with or without generalization treated with adjunctive LVT were assessed retrospectively through chart reviews and parent interviews. Data collected on each patient included age, seizure type(s), dose (mg/kg/day), concomitant therapies, response, side effects and length of therapy. Response and side effects were based on parent report. To assess response, patients needed to be on LVT at least 4 weeks.
RESULTS: 27 patients with focal onset epilepsy were identified with a mean age of 9.9 years (range 3.5-16 yrs). Seizures manifested as either simple partial (1), complex partial (11), complex partial and secondarily generalized (9), or purely secondarily generalized (6). Two patients discontinued LVT in less than 4 weeks due to side effects. Of the remaining (N=25) average dose was 32mg/kg/day. Concomitant therapies included valproate (9), lamotrigine (8), oxcarbazepine (7), topiramate (4), carbamazepine (2), phenytoin (2), zonisamide (2), felbamate (1), phenobarbital (1), acetazolamide (1), and vagal nerve stimulation (3). Mean and median length of therapy was 6 months (range 1-12 months). A 50% or more reduction was reported in 16(64%) with a greater than 75% reduction noted in 13(52%). 7 children (28%) were seizure free at the time of follow-up. Side effects were reported in 12(44%) and included behavioral/psychiatric symptoms (6), drowsiness (2), decreased appetite (1), tremor (1), and hypotonia (1). Of those with behavioral side effects, half had a pre-existing behavioral disorder which was significantly exacerbated during LVT therapy. Six discontinued therapy; 4 because of behavioral side effects and 2 because of lack of efficacy.
CONCLUSIONS: In the short term, LVT appears to be a safe, efficacious, adjunctive therapy for children with refractory focal epilepsy. Side effects were reported by nearly half of the group, but were generally mild. Only behavioral side effects were associated with discontinuation of therapy. Additional longer term studies need to be conducted to establish efficacy and tolerability of LVT therapy in children with refractory focal epilepsy.