Abstracts

To evaluate the efficacy and safety of levetiracetam (LEV) in refractory crypto/symptomatic, partial or generalised epilepsy in children, adolescents and young adults. we performed a prospective open label add-on study in 99 patients ( age 12 months-32 years, mean 14 years) with partial or generalised, crypto/symtpomatic seizures. Levetiracetam was added to no more than two baseline AEDs and the efficacy was rated according to seizure type and frequency.After an observation period of 6 months (if seizure frequency was one or more per day, baseline period could be shortened to 3 months) during which antiepileptic treatment was generally not changed in most cases except for particular reasons such as the occurrence of status epilepticus, LEV was added to the baseline therapy at the starting dose of 10 mg/kg/day with 5-day increments up to 60 mg/kg/day, unless it was not tolerated. Concomitant therapy was generally not modified throughout the study. after a mean follow-up period of 6.7 months (range 3 weeks-29 months), 11 patients (11.1%) were free of seizures (cryptogenic partial epilepsy, 5; symptomatic partial epilepsy, 6). A more than 75% seizure decrease was found in 14 pts (14.1 %) and -[gt] 50% in 8 (8.1 %). Seizures were unchanged in 38 (38.4%), and worsened in 23 (23.2%). Overall, the drug appeared to be more effective, though not significantly, in partial (40.6%) than in generalized epilepsy (20%) ([chi][sup2]= 1.676; p= .195). Levetiracetam was equally effective in both cryptogenic and symptomatic partial (p=0.971) or generalized (p=0.407) epilepsies.Seizure frequency increased with levetiracetam in 23 patients (23.2%). Almost all seizure types worsened with a mild prevalence in secondarily generalised seizures. Seizure worsening manifested generally during the first weeks of treatment at daily doses less than 20 mg/kg. In three patients seizures became very frequent, and promptly stopped after LEV withdrawal. Mean age in this group was 12.7 years and seizure frequency was daily or weekly in all patients.Mild and transient adverse side effects were found in 17 patients (17.2%), mostly represented by irritability and drowsiness. LEV appears to be well tolerated in children and adolescents with severe epilepsy and seems to be a broad spectrum AED, though in our experience, it was more effective against partial seizures with or without secondarily generalisation.