Abstracts

Rationale: Management of epilepsy in elderly patients is particularly challenging, due to comorbidity, medication requirements and age-related changes in drug distribution, metabolism and excretion. We present the results of our experience with levetiracetam (LEV) in a ‘pure’ population of elderly patients, with seizure onset after age 65 years.Methods: Male and female patients with seizure onset at age >65 years were included. Newly diagnosed patients received LEV monotherapy, initiated at 500 mg BID, uptitrated to 2000 mg/day and increased to 3000 mg/day if necessary. If seizure control was not established, a second antiepileptic drug (AED) was added and, if seizure freedom was achieved, LEV was withdrawn after 12 months follow-up. In patients already receiving ≥1 AED(s) without seizure control, LEV was administered as adjunctive therapy, initiated at 500 mg BID and uptitrated to 3000 mg/day maximum as required; if seizure freedom was achieved after 12 months follow-up, concomitant AEDs were gradually withdrawn and patients were maintained on LEV monotherapy. Efficacy was assessed as seizure frequency reduction; tolerability, by evaluating adverse events (AEs).Results: 66 patients (31 male, 35 female) were included. All had symptomatic epilepsy, with a variety of aetiologies. 45.5% (30/66) patients were newly diagnosed and received LEV monotherapy (2000 mg/day, n=14; 3000 mg/day, n=16) and 54.5% (36/66) received adjunctive LEV therapy (all 3000 mg/day). At the highest dosage, 56.7% (17/30) monotherapy patients achieved seizure freedom and 90.0% (27/30) demonstrated ≥50% seizure frequency reduction after 12 months follow-up. Addition of other AEDs to LEV did not increase the number of patients achieving seizure freedom. 16.7% (6/36) patients treated with adjunctive LEV therapy achieved seizure freedom and 41.7% (15/36) demonstrated ≥50% seizure frequency reduction after 12 months follow-up; 83.3% (5/6) patients who achieved seizure freedom were successfully transferred to LEV monotherapy. LEV was well tolerated and no patients withdrew due to AEs. The most frequently reported AE was somnolence (only at start of LEV treatment). No serious AEs were reported. Conclusions: LEV was effective and well tolerated in difficult-to-treat elderly epilepsy patients with a variety of aetiologies, when administered either as monotherapy or adjunctive therapy. These results suggest that LEV may be a useful alternative to other AEDs in the treatment of elderly epilepsy patients, both as adjunctive and first-line therapy.